north manchester general hospital lap vs_open_mr_luparini
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Francesco Luparini Colorectal Team - North Manchester General Hospital
Laparoscopic vs Laparotomic Resection for Rectal Cancer: Our Experience
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• Aim: to evaluate the differences of oncological clearance in Laparoscopic vs. Open Resection for Rectal AdenoCa
Aim of the StudySingle Centre Study
Oncological Clearance
Lymph Node Retrieval Lesion from Cut End Circumferential
Resection Margin
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Outline of the StudyPatients’ features
Laparoscopic OpenAge (m±DS) 67.8 ± 10.7 69.31 ± 12.35
M/F % 55% 59%
• Retrospective non-randomised study• Elective admissions for Anterior Resection in AdenoCa:
– 18 Laparoscopic vs. 42 Open• Period: Nov 2009 - Dec 2011 (25 months)
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• Laparoscopic group: 2 cases of Complete Tumor Regression (CTR) to neoadjuvant therapy
Duke’s Stage Distribution in the two groups
LAP
CTRTisABC
OPEN
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LAP OPEN0
5
10
15
20
25
30
35
40
45
No invasionVenous Invasion
27%33%
Venous InvasionSpreading of AdenoCa through vessels in two groups
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ResultsLymph nodes retrieval
With regard to lymph nodes, no difference has been seen in two groups (p=NS)
Lymph nodes LAP OPEN
m ± DS 13.0 ± 5.3 15.7 ± 5.63
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ResultsLesion from cut end (mm)
Distance from cut end LAP OPEN
m ± DS 56.4 ± 46.2 65.2 ± 64.9
range 15-200 0-300
With regard to distance of lesion from cut end, no difference has been seen in two groups (p=NS)
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ResultsCircumferential Resection Margin (mm)
With regard to CRM, no difference has been seen in two groups (p=NS)
CRM (mm) LAP OPEN
m ± DS 12.69 ± 7.49 16.42 ± 19.54
range 0 - 25 0 - 70
R1 resection 1/18 2/42
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• CT scan follow up (months): 8.5 ± 5.2
Follow-upResults
LAP OPENLocal Recurrence 1/18 2/42
Metastases 1 lung3 liver
1 lung3 liver
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ConclusionsRetrospective non-randomised study
In our experience Laparoscopic Resection has proven to be as effective as Open Resection with regard to:• Lymph node retrieval• Distance from cut end• Circumferential Resection Margin
Further follow-up is needed to evaluate the Oncological Outcome