Standardized Techniques for Laparoscopic Radical Rectal Resection and Its Application Prospect: Outcomes in 433 Patients and Review of The Literature_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TONG Weidong ¹ , GAO Yu ¹ , ZHANG Anping ¹ , LI Chunxue ¹ , ZHANG Lianyang ² , WANG Li ¹ , LI Fan ¹ , ZHAO Song ¹ , LIU Baohua. ¹

1.Department of Gastric &;
Colorectal Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China;;
2.Department of Trauma Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China;

Corresponding author：

Keywords：

Rectal cancer; Laparoscopic operation; Standardized surgery

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ObjectiveTo standardize the techniques for laparoscopic radical rectal resection and discuss its application prospect. MethodsThe clinical data of 433 patients who underwent laparoscopic radical rectal resections from July 2003 to December 2010 in our hospital were reviewed retrospectively, and the different surgery procedures and the development prospect were explored. ResultsFive cases (1.2%) underwent handassistant laparoscopic procedures, 412 cases (95.2%) were done by laparoscopic-assisted operation, and the specimens were taken out with transanal pull-through technique in 16 cases (3.7%). In all of them, conversion to open procedures occurred in 11 patients (2.5%), and 290 (67.0%) patients were followed-up in 1 to 6 years, average in 2.7 years. Local recurrence occurred in 7 (2.4%) patients, while distant metastasis were diagnosed in 22 （7.6%） cases, and the overall mortality was 15.9% (46/290). There was no port-site metastasis occurred. ConclusionsFour-port laparoscopic rectal resection technique is also the clinical mainstream. Standardized laparoscopic procedure for rectal resections enhances the transformation of laparoscopic skills, and makes the operation predictable. Single incision procedure and natural orifice transluminal endoscopic surgery are future direction to explore.

Citation： TONG Weidong,GAO Yu,ZHANG Anping,LI Chunxue,ZHANG Lianyang,WANG Li,LI Fan,ZHAO Song,LIU Baohua.. Standardized Techniques for Laparoscopic Radical Rectal Resection and Its Application Prospect: Outcomes in 433 Patients and Review of The Literature. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(11): 1151-1154. doi: Copy

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2.	Chand M, Heald RJ. Laparoscopic rectal cancer surgery [J]. Br J Surg, 2011, 98(2): 166167.
3.	Laurent C, Leblanc F, Wütrich P, et al. Laparoscopic versus open surgery for rectal cancer: longterm oncologic results [J]. Ann Surg, 2009, 250(1): 5461.
4.	Ng KH, Ng DC, Cheung HY, et al. Laparoscopic resection for rectal cancers: lessons learned from 579 cases [J]. Ann Surg, 2009, 249(1): 8286.
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6.	Wexner SD, Bergamaschi R, Lacy A, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference [J]. Surg Endosc, 2009, 23(2): 438443.
7.	Nandakumar G, Fleshman JW. Laparoscopy for rectal cancer [J]. Surg Oncol Clin N Am, 2010, 19(4): 793802.
8.	Bulut O, Nielsen CB. Singleincision laparoscopic low anterior resection for rectal cancer [J]. Int J Colorectal Dis, 2010, 25(10): 12611263.
9.	Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance [J]. Surg Endosc, 2010, 24(5): 12051210.
10.	Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer [J]. Br J Surg, 2009, 96(9): 982989.
11.	Yano H, Ohnishi T, Kanoh T, et al. Handassisted laparoscopic low anterior resection for rectal carcinoma [J]. J Laparoendosc Adv Surg Tech A, 2005, 15(6): 611614.
12.	Laurent C, Leblanc F, Gineste C, et al. Laparoscopic approach in surgical treatment of rectal cancer [J]. Br J Surg, 2007, 94(12): 15551561.
13.	da Luz Moreira A, Mor I, Geisler DP, et al. Laparoscopic resection for rectal cancer: a casematched study [J]. Surg Endosc, 2011, 25(1): 278283.
14.	Tjandra JJ, Chan MK, Yeh CH. Laparoscopic vs. handassisted ultralow anterior resection: a prospective study [J]. Dis Colon Rectum, 2008, 51(1): 2631.
15.	Popescu I, Vasilescu C, Tomulescu V, et al. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience [J]. Acta Chir Iugosl, 2010, 57(3): 2935.
16.	Lee KY， Kang J. Robotic colorectal surgery: Where are we right now? [J]. J Mech Eng Sci, 2010, 224(7): 14151419.
17.	Tuech JJ, Bridoux V, Kianifard B, et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance [J]. Eur J Surg Oncol, 2011, 37(4): 334335.
18.	Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 22002205.
19.	Lindsetmo RO, Delaney CP. A standardized technique for laparoscopic rectal resection [J]. J Gastrointest Surg, 2009, 13(11): 20592063.
20.	王超，王权，曹雪源，等．腹壁无瘢痕腹腔镜直肠癌根治术的3种标本取出途径 [J]．世界华人消化杂志， 2010， 18（22）： 23842386．.
21.	Akamatsu H, Omori T, Oyama T, et al. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique [J]. Dig Surg, 2009, 26(6): 446450.
22.	Abraham NS, Byrne CM, Young JM, et al. Metaanalysis of nonrandomized comparative studies of the shortterm outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007, 77(7): 508516.
23.	Gao F, Cao YF, Chen LS. Metaanalysis of shortterm outcomes after laparoscopic resection for rectal cancer [J]. Int J Colorectal Dis, 2006, 21(7): 652656.
24.	Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a metaanalysis [J]. Ann Surg Oncol, 2006, 13(3): 413424.

1. Ong EJ, Stevenson AR. Current state of laparoscopic rectal cancer surgery in Australasia [J]. ANZ J Surg, 2011, 81(4): 281286.
2. Chand M, Heald RJ. Laparoscopic rectal cancer surgery [J]. Br J Surg, 2011, 98(2): 166167.
3. Laurent C, Leblanc F, Wütrich P, et al. Laparoscopic versus open surgery for rectal cancer: longterm oncologic results [J]. Ann Surg, 2009, 250(1): 5461.
4. Ng KH, Ng DC, Cheung HY, et al. Laparoscopic resection for rectal cancers: lessons learned from 579 cases [J]. Ann Surg, 2009, 249(1): 8286.
5. 王国俊，高春芳．腹腔镜直肠癌全直肠系膜切除术 [J]．中国普外基础与临床杂志， 2011， 18（1）： 9294．.
6. Wexner SD, Bergamaschi R, Lacy A, et al. The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference [J]. Surg Endosc, 2009, 23(2): 438443.
7. Nandakumar G, Fleshman JW. Laparoscopy for rectal cancer [J]. Surg Oncol Clin N Am, 2010, 19(4): 793802.
8. Bulut O, Nielsen CB. Singleincision laparoscopic low anterior resection for rectal cancer [J]. Int J Colorectal Dis, 2010, 25(10): 12611263.
9. Sylla P, Rattner DW, Delgado S, et al. NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance [J]. Surg Endosc, 2010, 24(5): 12051210.
10. Lujan J, Valero G, Hernandez Q, et al. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer [J]. Br J Surg, 2009, 96(9): 982989.
11. Yano H, Ohnishi T, Kanoh T, et al. Handassisted laparoscopic low anterior resection for rectal carcinoma [J]. J Laparoendosc Adv Surg Tech A, 2005, 15(6): 611614.
12. Laurent C, Leblanc F, Gineste C, et al. Laparoscopic approach in surgical treatment of rectal cancer [J]. Br J Surg, 2007, 94(12): 15551561.
13. da Luz Moreira A, Mor I, Geisler DP, et al. Laparoscopic resection for rectal cancer: a casematched study [J]. Surg Endosc, 2011, 25(1): 278283.
14. Tjandra JJ, Chan MK, Yeh CH. Laparoscopic vs. handassisted ultralow anterior resection: a prospective study [J]. Dis Colon Rectum, 2008, 51(1): 2631.
15. Popescu I, Vasilescu C, Tomulescu V, et al. The minimally invasive approach, laparoscopic and robotic, in rectal resection for cancer. A single center experience [J]. Acta Chir Iugosl, 2010, 57(3): 2935.
16. Lee KY， Kang J. Robotic colorectal surgery: Where are we right now? [J]. J Mech Eng Sci, 2010, 224(7): 14151419.
17. Tuech JJ, Bridoux V, Kianifard B, et al. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance [J]. Eur J Surg Oncol, 2011, 37(4): 334335.
18. Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward [J]. Surg Endosc, 2010, 24(9): 22002205.
19. Lindsetmo RO, Delaney CP. A standardized technique for laparoscopic rectal resection [J]. J Gastrointest Surg, 2009, 13(11): 20592063.
20. 王超，王权，曹雪源，等．腹壁无瘢痕腹腔镜直肠癌根治术的3种标本取出途径 [J]．世界华人消化杂志， 2010， 18（22）： 23842386．.
21. Akamatsu H, Omori T, Oyama T, et al. Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique [J]. Dig Surg, 2009, 26(6): 446450.
22. Abraham NS, Byrne CM, Young JM, et al. Metaanalysis of nonrandomized comparative studies of the shortterm outcomes of laparoscopic resection for colorectal cancer [J]. ANZ J Surg, 2007, 77(7): 508516.
23. Gao F, Cao YF, Chen LS. Metaanalysis of shortterm outcomes after laparoscopic resection for rectal cancer [J]. Int J Colorectal Dis, 2006, 21(7): 652656.
24. Aziz O, Constantinides V, Tekkis PP, et al. Laparoscopic versus open surgery for rectal cancer: a metaanalysis [J]. Ann Surg Oncol, 2006, 13(3): 413424.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Standardized Techniques for Laparoscopic Radical Rectal Resection and Its Application Prospect: Outcomes in 433 Patients and Review of The Literature

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