Sie sind bereits registriert?
Loggen Sie sich mit Ihrem Universimed-Benutzerkonto ein:
Sie sind noch nicht registriert?
Registrieren Sie sich jetzt kostenlos auf universimed.com und erhalten Sie Zugang zu allen Artikeln, bewerten Sie Inhalte und speichern Sie interessante Beiträge in Ihrem persönlichen Bereich zum späteren Lesen. Ihre Registrierung ist für alle Unversimed-Portale gültig. (inkl. allgemeineplus.at & med-Diplom.at)
Laparoscopic vs. Open Surgery for Low Rectal Cancer
Laparoscopic surgery has been increasingly performed in recent decades across the spectrum of gastrointestinal malignancies, including rectal cancer. Is this approach as safe and effective as open surgery for patients with low rectal cancers?
To find out, investigators in China conducted a multicenter, noninferiority, randomized trial involving 1039 patients (median age, 57; 60% male) with locally advanced low-lying rectal cancers (63% clinical stage II/III; median distance from dentate line, 3 cm). Patients were assigned 2:1 to laparoscopic surgery (by surgeons who had performed >100 laparoscopic total mesorectal excision procedures) or open surgery.
Initial results, at 30 days postsurgery, were as follows:
- Operative time was longer with laparoscopic versus open surgery (195 vs. 180 min; P<0.001).
- Rates of intraoperative complications were similar between laparoscopic and open surgery (1.8% and 2.0%, respectively), as were rates of postoperative complications (13.0% and 17.2%).
- Durations of postsurgical analgesic use were shorter with laparoscopic versus open surgery (45.0 vs. 48.0 hours; P=0.001), as were hospital stays (8.0 vs. 9.0 days; P=0.008), and time to first defecation (61.2 vs. 66.3 hours; P=0.03).
- The rate of sphincter preservation was higher with laparoscopic versus open surgery (71.7% vs. 65.0%; P=0.03).
- The rate of anastomotic leak was lower with laparoscopic versus open surgery (2.5% vs. 5.1%).
- Rates of negative margins were similar between laparoscopic and open surgery (98.2% and 99.7%), as were rates of complete total mesorectal excision (85.3% and 85.8%) and the median number of lymph nodes retrieved (12.0 and 13.0).
These short-term results support the use of laparoscopic surgery by experienced surgeons for patients with low rectal cancer with a potential for improved outcomes, including higher rates of sphincter preservation. Longer follow-up is required for disease-free and overall survival outcomes to establish noninferiority for this approach.
Jiang W-Z et al.
Title: Short-term outcomes of laparoscopy-assisted vs open surgery for patients with low rectal cancer: The LASRE randomized clinical trial.
Source: JAMA Oncol 2022 Sep 15; [e-pub]. (Abstract/FREE Full Text)