Document Detail

Lymph node clearance after total mesorectal excision for rectal cancer: laparoscopic versus open approach.
MedLine Citation:
PMID:  17384514     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Laparoscopic resection of the rectum is still under scrutiny for its adequacy of oncological clearance. AIM: To assess lymph node yield after laparoscopic total mesorectal excision (TME) for rectal cancer as compared to the open approach. METHODS: 74 patients with middle and low rectal cancer were prospectively randomized in two groups. Group A included 39 patients who had an open TME (35 with low anterior resection of the rectum (LARR) and 4 with abdominoperineal resection of the rectum (APR)). In group B, there were 34 patients who had a laparoscopic TME (27 with LARR and 7 with APR). 10 of the LARR patients in group A and 14 of the LARR patients in group B had a defunctioning ileostomy. All operations were performed by one surgeon or under his supervision. RESULTS: Gender and age distribution were similar for both groups (group A: 23 males; mean age 69 (41-85); group B: 20 males; mean age 72 (31-84)). The mean distance of the tumor from the dentate line was 7.6 cm (1-12 cm) for group A and 6.1 cm (1-12 cm) for group B. Anastomosis was formed at a mean distance of 5.5 cm (1.5-8.5 cm) from the dentate line in group A and 3.5 cm (1-4.5 cm) in group B. At histology, in group A there were 5 T4 tumors, 9 T3, 10 T3+ (<1 mm distance from the circumferential resection margin), 13 T2 and 2 T1. In group B, there were 3 T4 tumors, 14 T3, 8 T3+, 7 T2 and 2 T1. Differences between groups were not significant. The mean number of lymph nodes retrieved in group A specimens was 19.2 (5-45) and in group B 19.2 (8-41) (p = 0.2). In group A, 3.9 (1-9) regional, 13.9 (3-34) intermediate and 1.5 (1-3) apical lymph nodes were retrieved. The respective values in group B were 3.7 (3-7), 14.4 (4-33) and 1.3 (1-3). Differences between groups were not significant. Also, the incidence of lymph node involvement by the tumor was not significantly different between groups (group A: 23; group B: 19). CONCLUSIONS: Laparoscopic resection of the rectum can achieve similar lymph node clearance to the open approach. Also, distribution of the lymph nodes along the resected specimens is similar between the two approaches.
George Pechlivanides; Nikolaos Gouvas; John Tsiaoussis; Anastasios Tzortzinis; Maria Tzardi; M Moutafidis; Christos Dervenis; Evaghelos Xynos
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Digestive diseases (Basel, Switzerland)     Volume:  25     ISSN:  0257-2753     ISO Abbreviation:  Dig Dis     Publication Date:  2007  
Date Detail:
Created Date:  2007-03-26     Completed Date:  2007-05-16     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  8701186     Medline TA:  Dig Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  94-9     Citation Subset:  IM    
Copyright Information:
Copyright 2007 S. Karger AG, Basel.
First Department of General Surgery, Athens Naval Hospital, Greece.
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MeSH Terms
Aged, 80 and over
Lymph Nodes / pathology*
Magnetic Resonance Imaging
Middle Aged
Neoplasm Staging
Pelvis / radiography
Preoperative Care
Rectal Neoplasms / pathology,  surgery*

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