Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHU Jun , DING Jianhua , TANG Haiyan , ZHANG Bin , ZHAO Yong , TONG Jing , ZHAO Ke

Department of Colorectal Surgery， The Gerneral Hospital of the Second Artillery of PLA， Center of Anorectal Disease of PLA， Beijing 100088， China;

Corresponding author：

Keywords：

Rectal neoplasm; Laparoscopy; Total mesorectal excision

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Objective 　To evaluate the feasibility, safety, radicality, and short-term and mid-term clinical outcomes of laparoscopic total mesorectal excision （TME） in comparison with open procedure for the middle-lower rectal cancer.
Methods 　From October 2005 to October 2008， 52 patients with middle-lower rectal cancer received laparoscopic TME （Dixon’operation） without preventive stoma， while 46 patients underwent conventional open TME （Dixon’operation） without preventive stoma. The operative procedures, clinicopathological data， and short-term and mid-term outcomes were collected and compared between the two groups.
Results 　The other patients were successful in both groups in addition to 2 （3.8%） patients were converted to open procedure in laparoscopic TME group. There was no perioperative death in both groups. The intraoperative blood loss, the time for bowel movement retrieval （first flatus）， and the incision healing in laparoscopic TME group were better than that in open TME group （P＜0.05）. No significant differences were observed between two groups in anastomotic leakage and pulmonary infection （P＞0.05）. Comparison of specimen, no significant differences were observed between two groups in negative distal margin and circumferential resection margin, number of lymph nodes resected, distance of distal resection margin to the tumor （P＞0.05）. No significant differences were observed between two groups in cancer-related death, local recurrence, distant metastasis, and 3-year survival rate （P＞0.05）.
Conclusions 　Laparoscopic TME for middle-low rectal cancer is a safe, feasible, and minimally invasive technique, and can achieve satisfactory oncological outcome, which provides similar short-term and mid-term outcome compared with the traditional open procedure.

Citation： ZHU Jun,DING Jianhua,TANG Haiyan,ZHANG Bin,ZHAO Yong,TONG Jing,ZHAO Ke,.. Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(6): 636-641. doi: Copy

1.	郑民华. 腹腔镜结直肠癌手术的应用现状与展望 [J]. 中华消化外科杂志， 2008， 7(3)：164-166.
2.	陆培华，陶圜清，沈伟，等. 国内腹腔镜结直肠切除术根治效果的Meta 分析 [J]. 中华消化外科杂志， 2008， 7(6)：458-460.
3.	顾晋，杜长征. 从解剖学角度谈中低位直肠癌术式选择 [J].中国实用外科杂志， 2009， 29(4)：300-302.
4.	Ng SS， Leung KL， Lee JF， et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer：a prospective randomized trial [J]. Ann Surg Oncol， 2008， 15(9)：2418-2425.
5.	Romano G， Gagliardi G， Bianco F， et al. Laparoscopic colorectal surgery：why it is still not the gold standard and why it should be [J]. Tech Coloproctol， 2008， 12(2)：185-188.
6.	Rosin D， Lebedyev A， Urban D， et al. Laparoscopic resection of rectal cancer [J]. Isr Med Assoc J， 2011， 13(8)：459-462.
7.	Pikarsky AJ， Rosenthal R， Weiss EG， et al. Laparoscopic total mesorectal excision [J]. Surg Endosc， 2002， 16(4)：558-562.
8.	中国抗癌协会大肠癌专业委员会腹腔镜外科学组，中华医学会外科分会腹腔镜与内镜外科学组. 腹腔镜结肠直肠癌根治性手术操作指南(2006 版) [J]. 外科理论与实践， 2006，.
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12.	Koopmann MC， Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease [J]. Surg Clin North Am， 2008， 88(5)：1047-1072.
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14.	Laurent C， Leblanc F， Bretagnol F， et al. Long-term wound advantages of the laparoscopic approach in rectal cancer [J]. Br J Surg， 2008， 95(7)：903-908.
15.	黄石川，游志坚，梁子君，等. 腹腔镜结直肠肿瘤手术18 例报道 [J]. 中国普外基础与临床杂志， 2008， 15(10)：722-725.
16.	郑民华，李健文，陆爱国，等. 腹腔镜结直肠手术的学习曲线 [J]. 外科理论与实践， 2002， 7(3)：187-189.
17.	Ito M， Sugito M， Kobayashi A， et al. Influence of learning curve on short-term results after laparoscopic resection for rectal cancer [J]. Surg Endosc， 2009， 23(2)：403-408.
18.	池畔，林惠铭. 腹腔镜结直肠癌根治术学习曲线 [J]. 中华胃肠外科杂志， 2004， 7(5)：372-374.
19.	Lange MM， Buunen M， van de Velde CJ， et al. Level of arterial ligation in rectal cancer surgery：low tie preferred over high tie. A review [J]. Dis Colon Rectum， 2008， 51(7)：1139-1145.
20.	Fazio S， Ciferri E， Giacchino P， et al. Cancer of the rectum：comparison of two different surgical approaches [J]. Chir Ital，2004， 56(1)：23-30.
21.	Sato K， Inomata M， Kakisako K， et al. Surgical technique influences bowel function after low anterior resection and sigmoidcolectomy [J]. Hepatogastroenterology， 2003， 50(53)：1381-1384.
22.	Washington MK， Berlin J， Branton P， et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum [J]. Arch Pathol Lab Med， 2009， 133(10)：1539-1551.
23.	Dent OF， Haboubi N， Chapuis PH， et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer [J]. Colorectal Dis， 2007， 9(2)：112-121.
24.	Glynne-Jones R， Mawdsley S， Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer：why we need a common language [J]. Colorectal Dis， 2006， 8(9)：800-807.
25.	Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
26.	Anderson C， Uman G， Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer：a systematic review and metaanalysis of the literature [J]. Eur J Surg Oncol， 2008， 34(10)：1135-1142.
27.	梁小波，侯生槐，李国栋，等. 腹腔镜直肠癌手术的疗效分析 [J]. 中华消化外科杂志， 2010， 9(6)：411-414.
28.	施小龙，池畔，林惠铭. 腹腔镜结直肠癌根治术疗效分析 [J].中华消化外科杂志， 2010， 9(3)：207-209.
29.	Mirza MS， Longman RJ， Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [J]. J Laparoendosc Adv Surg Tech A， 2008，18(5)：679-685.
30.	Bretagnol F， Lelong B， Laurent C， et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma [J]. Surg Endosc， 2005， 19(7)：892-896.
31.	Jingli C， Rong C， Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [J]. Surg Endosc， 2006， 20(11)：1759-1761.
32.	Miyajima N， Fukunaga M， Hasegawa H， et al. Results of a multicenter study of 1 057 cases of rectal cancer treated by laparoscopic surgery [J]. Surg Endosc， 2009， 23(1)：113-118.
33.	范莹，吴硕东，于宏，等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究 [J]. 中国普外基础与临床杂志， 2009， 16(5)：384-388.
34.	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.
35.	Huang MJ， Liang JL， Wang H， et al. Laparoscopic-assisted versus open surgery for rectal cancer：a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes [J]. Int J Colorectal Dis， 2011， 26(4)：415-421.
36.	Liang Y， Li G， Chen P， et al. Laparoscopic versus open colorectal resection for cancer：a meta-analysis of results of randomized controlled trials on recurrence [J]. Eur J Surg Oncol， 2008，34(11)：1217-1224.

1. 郑民华. 腹腔镜结直肠癌手术的应用现状与展望 [J]. 中华消化外科杂志， 2008， 7(3)：164-166.
2. 陆培华，陶圜清，沈伟，等. 国内腹腔镜结直肠切除术根治效果的Meta 分析 [J]. 中华消化外科杂志， 2008， 7(6)：458-460.
3. 顾晋，杜长征. 从解剖学角度谈中低位直肠癌术式选择 [J].中国实用外科杂志， 2009， 29(4)：300-302.
4. Ng SS， Leung KL， Lee JF， et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer：a prospective randomized trial [J]. Ann Surg Oncol， 2008， 15(9)：2418-2425.
5. Romano G， Gagliardi G， Bianco F， et al. Laparoscopic colorectal surgery：why it is still not the gold standard and why it should be [J]. Tech Coloproctol， 2008， 12(2)：185-188.
6. Rosin D， Lebedyev A， Urban D， et al. Laparoscopic resection of rectal cancer [J]. Isr Med Assoc J， 2011， 13(8)：459-462.
7. Pikarsky AJ， Rosenthal R， Weiss EG， et al. Laparoscopic total mesorectal excision [J]. Surg Endosc， 2002， 16(4)：558-562.
8. 中国抗癌协会大肠癌专业委员会腹腔镜外科学组，中华医学会外科分会腹腔镜与内镜外科学组. 腹腔镜结肠直肠癌根治性手术操作指南(2006 版) [J]. 外科理论与实践， 2006，.
9. 中国抗癌协会大肠癌专业委员会. 中低位直肠癌外科治疗规范( 草案) [J]. 中华胃肠外科杂志， 2005， 8(1)：88-90.
10. Jamali FR， Soweid AM， Dimassi H， et al. Evaluating the degree of difficulty of laparoscopic colorectal surgery [J]. Arch Surg，2008， 143(8)：762-767.
11. (5)：462-464.
12. Koopmann MC， Heise CP. Laparoscopic and minimally invasive resection of malignant colorectal disease [J]. Surg Clin North Am， 2008， 88(5)：1047-1072.
13. Buchanan GN， Malik A， Parvaiz A， et al. Laparoscopic resection for colorectal cancer [J]. Br J Surg， 2008， 95(7)：893-902.
14. Laurent C， Leblanc F， Bretagnol F， et al. Long-term wound advantages of the laparoscopic approach in rectal cancer [J]. Br J Surg， 2008， 95(7)：903-908.
15. 黄石川，游志坚，梁子君，等. 腹腔镜结直肠肿瘤手术18 例报道 [J]. 中国普外基础与临床杂志， 2008， 15(10)：722-725.
16. 郑民华，李健文，陆爱国，等. 腹腔镜结直肠手术的学习曲线 [J]. 外科理论与实践， 2002， 7(3)：187-189.
17. Ito M， Sugito M， Kobayashi A， et al. Influence of learning curve on short-term results after laparoscopic resection for rectal cancer [J]. Surg Endosc， 2009， 23(2)：403-408.
18. 池畔，林惠铭. 腹腔镜结直肠癌根治术学习曲线 [J]. 中华胃肠外科杂志， 2004， 7(5)：372-374.
19. Lange MM， Buunen M， van de Velde CJ， et al. Level of arterial ligation in rectal cancer surgery：low tie preferred over high tie. A review [J]. Dis Colon Rectum， 2008， 51(7)：1139-1145.
20. Fazio S， Ciferri E， Giacchino P， et al. Cancer of the rectum：comparison of two different surgical approaches [J]. Chir Ital，2004， 56(1)：23-30.
21. Sato K， Inomata M， Kakisako K， et al. Surgical technique influences bowel function after low anterior resection and sigmoidcolectomy [J]. Hepatogastroenterology， 2003， 50(53)：1381-1384.
22. Washington MK， Berlin J， Branton P， et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum [J]. Arch Pathol Lab Med， 2009， 133(10)：1539-1551.
23. Dent OF， Haboubi N， Chapuis PH， et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer [J]. Colorectal Dis， 2007， 9(2)：112-121.
24. Glynne-Jones R， Mawdsley S， Novell JR. The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer：why we need a common language [J]. Colorectal Dis， 2006， 8(9)：800-807.
25. Nagtegaal ID， Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer? [J]. J Clin Oncol， 2008， 26(2)：303-312.
26. Anderson C， Uman G， Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer：a systematic review and metaanalysis of the literature [J]. Eur J Surg Oncol， 2008， 34(10)：1135-1142.
27. 梁小波，侯生槐，李国栋，等. 腹腔镜直肠癌手术的疗效分析 [J]. 中华消化外科杂志， 2010， 9(6)：411-414.
28. 施小龙，池畔，林惠铭. 腹腔镜结直肠癌根治术疗效分析 [J].中华消化外科杂志， 2010， 9(3)：207-209.
29. Mirza MS， Longman RJ， Farrokhyar F， et al. Long-term outcomes for laparoscopic versus open resection of nonmetastatic colorectal cancer [J]. J Laparoendosc Adv Surg Tech A， 2008，18(5)：679-685.
30. Bretagnol F， Lelong B， Laurent C， et al. The oncological safety of laparoscopic total mesorectal excision with sphincter preservation for rectal carcinoma [J]. Surg Endosc， 2005， 19(7)：892-896.
31. Jingli C， Rong C， Rubai X. Influence of colorectal laparoscopic surgery on dissemination and seeding of tumor cells [J]. Surg Endosc， 2006， 20(11)：1759-1761.
32. Miyajima N， Fukunaga M， Hasegawa H， et al. Results of a multicenter study of 1 057 cases of rectal cancer treated by laparoscopic surgery [J]. Surg Endosc， 2009， 23(1)：113-118.
33. 范莹，吴硕东，于宏，等. 腹腔镜结直肠癌根治术与同期开腹手术对比的单中心回顾性研究 [J]. 中国普外基础与临床杂志， 2009， 16(5)：384-388.
34. 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.
35. Huang MJ， Liang JL， Wang H， et al. Laparoscopic-assisted versus open surgery for rectal cancer：a meta-analysis of randomized controlled trials on oncologic adequacy of resection and long-term oncologic outcomes [J]. Int J Colorectal Dis， 2011， 26(4)：415-421.
36. Liang Y， Li G， Chen P， et al. Laparoscopic versus open colorectal resection for cancer：a meta-analysis of results of randomized controlled trials on recurrence [J]. Eur J Surg Oncol， 2008，34(11)：1217-1224.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Versus Open Total Mesorectal Excision in Treatment of Middle-Low Rectal Cancer：A Clinical Comparative Study

Abstract Full text Figures/Tables Video References Cited by

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