Laparoskopische Operationen bei Rektumkarzinomen. Kurzzeitvorteile und onkologische ergebnisse beim einsatz von mehr als einer methode

Purpose. A number of minimally invasive techniques have now been described for rectal cancer resection. However, current outcome data for these approaches from high-volume single institutions remain limited. Our aim was to review outcomes in patients currently undergoing minimally invasive surgery for rectal cancer at our institution.Methods. A retrospective analysis was performed to assess short-term benefits and oncologic outcomes in patients undergoing minimally invasive surgery for rectal cancer between 2004 and 2007.Results. A total of 100 consecutive patients (61 men, median age 62) with a median follow-up of 1.8 years were identified. Of these, 67 underwent hand-assisted laparoscopic surgery (HALS) and 33 laparoscopic-assisted (LA) procedures. In all, 72 patients underwent anterior resection, 27 abdominal perineal resection, and one total proctocolectomy. Tumor stages were stage 1 (21%), stage 2 (17%), stage 3 (56%), and stage 4 (6%). A median of 16 lymph nodes were removed, while both a median distal margin of 3.4 cm and a 99% negative circumferential margin were achieved. The 3-year disease-free and overall survival rates were 86.2 and 94.5%, respectively. Three cases required conversion. Median time to both food intake and first bowel movement was 3 days, while the median length of stay was 5 days. Length of stay, time to soft diet, incision length, and pain scores were less using an LA approach compared to HALS (P<0.01). Overall morbidity was 26% with no mortality.Conclusions. Both minimally invasive techniques used achieved excellent oncologic results in patients with rectal cancer. The LA approach had slightly better short-term outcomes.