Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective
Background: Laparoscopic resection for rectal cancer (LRR) has gained popularity because of better short-term outcomes and less post-operative morbidity. However, LRR is still not endorsed as a standard of care mainly due to concerns centred on oncological safety in comparison with open approach. Mo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Journal of Minimal Access Surgery |
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| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2020;volume=16;issue=3;spage=251;epage=255;aulast=Veerankutty |
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| author | Fadl H Veerankutty Nandu Nair Sidharth Chacko Vipin I Sreekumar Deepak Varma Prakash Kurumboor |
| author_facet | Fadl H Veerankutty Nandu Nair Sidharth Chacko Vipin I Sreekumar Deepak Varma Prakash Kurumboor |
| author_sort | Fadl H Veerankutty |
| collection | DOAJ |
| description | Background: Laparoscopic resection for rectal cancer (LRR) has gained popularity because of better short-term outcomes and less post-operative morbidity. However, LRR is still not endorsed as a standard of care mainly due to concerns centred on oncological safety in comparison with open approach. Moreover, two recent randomised trials (Australian Laparoscopic Cancer of the Rectum [ALaCaRT] and the American College of Surgeons Oncology Group [ACOSOG] Z6051) have failed to prove that LRR is non-inferior to open resection. Studies on oncological adequacy of LRR in the Indian population in terms of quality of mesorectal excision are scarce. In this article, we aim to audit the oncological adequacy of LRR in our centre and thereby critically analyse the reliability of extrapolation of results of ALaCaRT and ACOSOG trials to the Indian population.
Methods: We retrospectively analysed the oncological adequacy of LRR in terms of completeness of total mesorectal excision (TME), distal and circumferential resection margin (CRM) status and nodal harvest in patients with rectal cancer who underwent LRR between January 2016 and June 2018 at our centre.
Results: Of 157 patients included in this study, a complete TME was achieved in 148 (94.26%) patients and nearly complete in 7 (4.46%) patients. A safe CRM (≥1 mm) was obtained in 151 (96.18%) patients. Distal margin results were negative in 155 (98.73%) patients. Average nodal harvest was 19.86 ± 9.28. Overall surgical success, calculated as a composite measure of negative distal margin and negative CRM and complete TME was 95.54%.
Conclusion: Good quality rectal cancer resection can be achieved by experienced laparoscopic surgeons without compromising oncological safety. |
| first_indexed | 2024-12-22T17:30:23Z |
| format | Article |
| id | doaj.art-14d6d822d2a44741969dfdccbac20b2b |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-12-22T17:30:23Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-14d6d822d2a44741969dfdccbac20b2b2022-12-21T18:18:38ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212020-01-0116325125510.4103/jmas.JMAS_272_18Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspectiveFadl H VeerankuttyNandu NairSidharth ChackoVipin I SreekumarDeepak VarmaPrakash KurumboorBackground: Laparoscopic resection for rectal cancer (LRR) has gained popularity because of better short-term outcomes and less post-operative morbidity. However, LRR is still not endorsed as a standard of care mainly due to concerns centred on oncological safety in comparison with open approach. Moreover, two recent randomised trials (Australian Laparoscopic Cancer of the Rectum [ALaCaRT] and the American College of Surgeons Oncology Group [ACOSOG] Z6051) have failed to prove that LRR is non-inferior to open resection. Studies on oncological adequacy of LRR in the Indian population in terms of quality of mesorectal excision are scarce. In this article, we aim to audit the oncological adequacy of LRR in our centre and thereby critically analyse the reliability of extrapolation of results of ALaCaRT and ACOSOG trials to the Indian population. Methods: We retrospectively analysed the oncological adequacy of LRR in terms of completeness of total mesorectal excision (TME), distal and circumferential resection margin (CRM) status and nodal harvest in patients with rectal cancer who underwent LRR between January 2016 and June 2018 at our centre. Results: Of 157 patients included in this study, a complete TME was achieved in 148 (94.26%) patients and nearly complete in 7 (4.46%) patients. A safe CRM (≥1 mm) was obtained in 151 (96.18%) patients. Distal margin results were negative in 155 (98.73%) patients. Average nodal harvest was 19.86 ± 9.28. Overall surgical success, calculated as a composite measure of negative distal margin and negative CRM and complete TME was 95.54%. Conclusion: Good quality rectal cancer resection can be achieved by experienced laparoscopic surgeons without compromising oncological safety.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2020;volume=16;issue=3;spage=251;epage=255;aulast=Veerankuttycircumferential resection margincolorectal neoplasmslaparoscopyminimally invasive surgeryquality of surgeryrectal cancertotal mesorectal excision |
| spellingShingle | Fadl H Veerankutty Nandu Nair Sidharth Chacko Vipin I Sreekumar Deepak Varma Prakash Kurumboor Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective Journal of Minimal Access Surgery circumferential resection margin colorectal neoplasms laparoscopy minimally invasive surgery quality of surgery rectal cancer total mesorectal excision |
| title | Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective |
| title_full | Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective |
| title_fullStr | Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective |
| title_full_unstemmed | Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective |
| title_short | Oncological adequacy of laparoscopic rectal cancer resection: An audit in Indian perspective |
| title_sort | oncological adequacy of laparoscopic rectal cancer resection an audit in indian perspective |
| topic | circumferential resection margin colorectal neoplasms laparoscopy minimally invasive surgery quality of surgery rectal cancer total mesorectal excision |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2020;volume=16;issue=3;spage=251;epage=255;aulast=Veerankutty |
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