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Short- and Mid-Term Outcomes after Endoscopic Transanal or Laparoscopic Transabdominal Total Mesorectal Excision for Low Rectal Cancer: A Single Institutional Case-Control Study
- Source :
- Journal of the American College of Surgeons. 224:917-925
- Publication Year :
- 2017
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2017.
-
Abstract
- Background Transabdominal laparoscopic proctectomy (LAP) for rectal cancer was associated with postoperative recovery improvement. Early studies showed favorable short-term results of endoscopic transanal proctectomy (ETAP), with low conversion rates to open procedures. We aimed to compare efficacy, morbidity, and functional outcomes of ETAP to standard LAP for low rectal cancer. Study Design From 2008 to 2013, 72 consecutive patients received proctectomy and coloanal manual anastomosis for low rectal adenocarcinoma. Thirty-four patients had transanal endoscopic proctectomy, and 38 patients underwent the standard laparoscopic procedure. Results When compared with the LAP group, the ETAP group demonstrated a lower conversion rate to open procedures (23.7% vs 2.9%, respectively; p = 0.015), shorter in-hospital stays (9 vs 8 days, respectively; p = 0.04), and a lower readmission rate (13.2% vs 0%; p = 0.03). Overall postoperative morbidity rates for the LAP and the ETAP groups (36.8% vs 32.4%, respectively; p = 0.69) and functional results (Kirwan score 1/2, 73.7% vs 73.5%, respectively; p = 0.85) were comparable; additionally, we found similar oncologic quality criteria (R1 resection 10.5% vs 5.9%, respectively; p = 0.68; grade 3 mesorectal integrity 52.6% vs 55.9%, respectively; p = 0.66). Disease-free survival of 24 months (Kaplan-Meier estimation) was comparable in the 2 groups: 86% in the ETAP group vs 88% in the LAP group; p = 0.91. At the date of last follow-up, 91.2% of ETAP patients and 92.1% of LAP patients were free of stoma. Conclusions The endoscopic transanal approach could facilitate mesorectal excision and improve short-term outcomes without impairing the oncologic quality of the resection or mid-term functional and oncologic results.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
Colorectal cancer
Adenocarcinoma
Anastomosis
Patient Readmission
Disease-Free Survival
Transanal Endoscopic Surgery
Stoma
Young Adult
03 medical and health sciences
0302 clinical medicine
medicine
Rectal Adenocarcinoma
Humans
Laparoscopy
Mesorectal
medicine.diagnostic_test
Rectal Neoplasms
business.industry
Recovery of Function
Length of Stay
Middle Aged
medicine.disease
Total mesorectal excision
Surgery
Treatment Outcome
Case-Control Studies
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
business
Subjects
Details
- ISSN :
- 10727515
- Volume :
- 224
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi.dedup.....3f0ea54a9284182d5e3034b9bd1e9a63