Comparison Between Laparoscopic and Open Radical Operation in Patients with Rectal Cancer of Different Ages_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIANG Hui , GUAN Wei , CHEN Guoyu

Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, ChinaCorresponding Author: LIANG Hui, E-mail: lianghuilph@hotmail.com;

Corresponding author：

Keywords：

Laparoscope; Rectal resection; Rectal cancer; Elderly patient; Complication

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Objective 　To evaluate the feasibility of laparoscopic rectal resection (LR) in elderly and younger patients with rectal cancer.
Methods 　From January 2008 to March 2009, 76 patients with rectal cancer undergoing elective rectal resection were included in this study. Older than 70 years named elderly group, in which LR was given to 16 cases, and open resection (OR) to 18 cases. Younger than 70 years named younger group, in which LR was performed in 23 cases, and OR in 19 cases. The results after LR and OR in rectal cancer between 2 groups of patients were compared.
Results 　No surgery-assisted death occurred in either group. In 2 groups, ventilation time, intake food time and hospitalization after operation in LR were shorter than those of OR (P＜0.05， P＜0.01); intraoperative blood loss and the proportion of postoperative analgesia in LR were less than those of OR in 2 groups (P＜0.01); there were no significant differences between LR and OR (P gt;0.05) in mean operation time or number of lymph node resected. In addition to the incision infection rate, the other complications rates and the postoperative life self-care rate between LR and OR were no significantly different in younger group (P gt;0.05). In the elderly group, every complication rates of LR were lower than those of OR (P＜0.05), oppositely, the postoperative life self-care rate was higher (P＜0.01).
Conclusions 　LR of rectal cancer can be applied to both elderly and younger patients. It is suggested that advanced age should not be the contraindication for LR, and by contrary elderly patients may be particularly indicated for lower postoperative complications rate compared to open surgeries.

Citation： LIANG Hui,GUAN Wei,CHEN Guoyu. Comparison Between Laparoscopic and Open Radical Operation in Patients with Rectal Cancer of Different Ages. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(10): 789-792. doi: Copy

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2.	Delaney CP, Kiran RP, Senagore AJ, et al. Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery [Ｊ]. Ann Surg, 2003; 238(1): 67-72.
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.	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.
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6.	Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery? [Ｊ]. Surg Endosc, 2008; 22(2): 401-405.
7.	Chautard J, Alves A, Zalinski S, et al. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients [Ｊ]. J Am Coll Surg, 2008; 206(2): 255-260.
8.	Nelson H, Sargent D, Wieand HS, et al. For the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [Ｊ]. N Engl J Med， 2004; 350: 2050-2059.
9.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? [Ｊ]. Br J Surg, 1982; 69(10): 613-616.
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11.	Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes [Ｊ]. Surg Endosc, 2004; 18(2): 281-289.
12.	郑民华, 马君俊. 腹腔镜外科在争议中发展 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(5): 503-505.
13.	吴东波, 黄顺荣, 吴鸿根, 等. 改良腹腔镜Dixon手术和开腹Dixon手术的临床对照研究(附58例报道) [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 211-214.
14.	张策, 李国新, 丁自海, 等. 直肠癌外科与自主神经保留: 肠系膜下动脉结扎的神经解剖因素 [Ｊ]. 南方医科大学学报, 2006； 26(1): 49-52.
15.	Weiser MR, Milsom JW. Laparoscopic total mesorectal excision with autonomic nerve preservation [Ｊ]. Semin Surg Oncol, 2000; 19(4): 396-403.
16.	Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients [Ｊ]. J Am Coll Surg, 2006; 203(6): 865-877.
17.	Avital S, Itah R, Szomstein S, et al. Correlation of CO2 pneumoperitoneal pressures between rodents and humans [Ｊ]. Surg Endosc, 2009; 23(1): 50-54.
18.	Meininger D, Byhahn C. Special features of laparoscopic operations from an anesthesiologic viewpoint: a review [Ｊ]. Anaesthesist, 2008; 57(8): 760-766.
19.	Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum [Ｊ]. J Gastrointest Surg, 2009; 13(5): 1009-1016.
20.	Firilas A, Duke BE, Max MH. Laparoscopic cholecystectomy in the elderly [Ｊ]. Surg Endosc, 1996; 10(1): 33-35.
21.	Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly [Ｊ]. Br J Surg, 1999; 86(7): 938-941.
22.	郑民华. 腹腔镜手术对胃肠动力的影响 [Ｊ]. 中国实用外科杂志, 2003; 23(8): 451-453.
23.	Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial [Ｊ]. Lancet, 2002; 359(9325): 2224-2229.
24.	刘国礼. 腹腔镜手术治疗胃肠疾病的现状 [Ｊ]. 腹部外科, 2008； 21(1): 5-7.
25.	Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy [Ｊ]. Surg Endosc, 2003; 17(2): 342-350.

1. Weber DM. Laparoscopic surgery: an excellent approach in elderly patients [Ｊ]. Arch Surg, 2003; 138(10): 1083-1088.
2. Delaney CP, Kiran RP, Senagore AJ, et al. Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery [Ｊ]. Ann Surg, 2003; 238(1): 67-72.
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. 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.
5. Latkauskas T, Rudinskaite G, Kurtinaitis J, et al. The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment [Ｊ]. BMC Cancer, 2005; 5: 153.
6. Person B, Cera SM, Sands DR, et al. Do elderly patients benefit from laparoscopic colorectal surgery? [Ｊ]. Surg Endosc, 2008; 22(2): 401-405.
7. Chautard J, Alves A, Zalinski S, et al. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients [Ｊ]. J Am Coll Surg, 2008; 206(2): 255-260.
8. Nelson H, Sargent D, Wieand HS, et al. For the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [Ｊ]. N Engl J Med， 2004; 350: 2050-2059.
9. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence? [Ｊ]. Br J Surg, 1982; 69(10): 613-616.
10. 周总光, 王昭. 直肠癌根治－腔镜下TME: 现状与评价 [Ｊ]. 中国实用外科杂志, 2003； 23(5): 261-262.
11. Leroy J, Jamali F, Forbes L, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes [Ｊ]. Surg Endosc, 2004; 18(2): 281-289.
12. 郑民华, 马君俊. 腹腔镜外科在争议中发展 [Ｊ]. 中国普外基础与临床杂志, 2007; 14(5): 503-505.
13. 吴东波, 黄顺荣, 吴鸿根, 等. 改良腹腔镜Dixon手术和开腹Dixon手术的临床对照研究(附58例报道) [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 211-214.
14. 张策, 李国新, 丁自海, 等. 直肠癌外科与自主神经保留: 肠系膜下动脉结扎的神经解剖因素 [Ｊ]. 南方医科大学学报, 2006； 26(1): 49-52.
15. Weiser MR, Milsom JW. Laparoscopic total mesorectal excision with autonomic nerve preservation [Ｊ]. Semin Surg Oncol, 2000; 19(4): 396-403.
16. Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients [Ｊ]. J Am Coll Surg, 2006; 203(6): 865-877.
17. Avital S, Itah R, Szomstein S, et al. Correlation of CO2 pneumoperitoneal pressures between rodents and humans [Ｊ]. Surg Endosc, 2009; 23(1): 50-54.
18. Meininger D, Byhahn C. Special features of laparoscopic operations from an anesthesiologic viewpoint: a review [Ｊ]. Anaesthesist, 2008; 57(8): 760-766.
19. Grabowski JE, Talamini MA. Physiological effects of pneumoperitoneum [Ｊ]. J Gastrointest Surg, 2009; 13(5): 1009-1016.
20. Firilas A, Duke BE, Max MH. Laparoscopic cholecystectomy in the elderly [Ｊ]. Surg Endosc, 1996; 10(1): 33-35.
21. Stewart BT, Stitz RW, Lumley JW. Laparoscopically assisted colorectal surgery in the elderly [Ｊ]. Br J Surg, 1999; 86(7): 938-941.
22. 郑民华. 腹腔镜手术对胃肠动力的影响 [Ｊ]. 中国实用外科杂志, 2003; 23(8): 451-453.
23. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial [Ｊ]. Lancet, 2002; 359(9325): 2224-2229.
24. 刘国礼. 腹腔镜手术治疗胃肠疾病的现状 [Ｊ]. 腹部外科, 2008； 21(1): 5-7.
25. Beger HG, Schwarz A, Bergmann U. Progress in gastrointestinal tract surgery: the impact of gastrointestinal endoscopy [Ｊ]. Surg Endosc, 2003; 17(2): 342-350.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison Between Laparoscopic and Open Radical Operation in Patients with Rectal Cancer of Different Ages

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