Document Detail


Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum.
MedLine Citation:
PMID:  11961595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Within a 5-year period, 380 rectal carcinoma patients undergoing laparoscopic abdominoperineal excision or laparoscopic anterior resection were recruited to a multicenter study by 23 institutions in Germany and Austria. This study was initiated by the Laparoscopic Colorectal Surgery Study Group. RESULTS: One hundred forty-nine patients (39.2%) underwent abdominoperineal resection (APR), and 231 patients (60.8%) were treated by anterior resection (AR). The mean operating time was 208 min, and the conversion rate was 6.1%. Intraoperative complications, mostly vascular or bowel injuries, were observed in 22 patients (5.8%). Overall, a total of 257 postoperative complications and problems occurred in 143 patients, resulting in a morbidity rate of 37.6%. In the AR group, the anastomotic leakage rate increased as the distance of the tumor from the anal verge decreased. The perioperative mortality rate was low (6/1.6%). Most of the patients received a high transsection of the inferior mesenteric artery with radical lymph node dissection (342/90.0%); the mean number of recovered lymph nodes was 13.0, with considerable variation among the individual institutions. Intraoperative tumor cell spillage was reported in 12 patients (3.2%). Sufficient follow-up findings are available for 288 (77%) patients. To date, 19 patients have sustained a local recurrence (6.6%), and 30 (10.4%) have developed distant metastases. Within the (admittedly limited) mean follow-up of 24.8 months, the overall survival rate is 86.6%, the disease-free survival (freedom from both local recurrence and distant metastases) rate is 62.4% for APR, with the corresponding rates for AR being 71.7 and 54.8%, respectively, as established by the Kaplan-Meier function. These data show no alarmingly high recurrence rates at this time. CONCLUSION: In principle, laparoscopic anterior resection with curative intent generates considerably more reservations than laparoscopic abdominoperineal resection, which is technically much easier to perform.
Authors:
H Scheidbach; C Schneider; J Konradt; E Bärlehner; L Köhler; Ch Wittekind; F Köckerling
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2001-11-12
Journal Detail:
Title:  Surgical endoscopy     Volume:  16     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-04-18     Completed Date:  2002-05-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  7-13     Citation Subset:  IM    
Affiliation:
Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Roesebeckstrasse 15 (Siloah), D-30449 Hannover, Germany. Hubert.Scheidbach.Siloah@klinikum-hannover.de
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MeSH Terms
Descriptor/Qualifier:
Abdomen / surgery*
Aged
Aged, 80 and over
Carcinoma / surgery*
Female
Follow-Up Studies
Humans
Intraoperative Complications
Laparoscopy / methods*
Male
Middle Aged
Neoplasm Staging
Perineum / surgery*
Prospective Studies
Rectal Neoplasms / surgery*
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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