|Title:||Laparoscopic Abdominoperineal Resection for Lower Rectal Cancers||Authors:||LIANG, JIN-TUNG
|Keywords:||rectal cancer;laparoscopic surgery;abdominoperineal resection||Issue Date:||2006||Journal Volume:||v.20||Journal Issue:||n.4||Start page/Pages:||69-5||Source:||SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES||Abstract:||
Background: The appropriateness of the laparoscopic approach for the resection of rectal cancer has been controversial, although it is well established in colon cancer. This is a phase 11 study of laparoscopic abdominoperineal resection ( APR) in the treatment of lower rectal cancers . Methods: Patients with lower rectal adenocarcinoma located within 6 cm above the anal verae were recruited and subjected to laparoscopic APR. The surgical principle included en bloc resection with high ligation of inferior mesenteric vessels by no-touch isolation and total mesorectal excision. Details of the surgical procedures are presented in the video. The technical efficiency and outcome of this Surgical approach were evaluated prospectively. This Study was approved by the institutional review board of National Taiwan University Hospital (NTUH). Results A total of 22 patients were enrolled in the Study from January 2003 to December 2004 under the ethical guidelines of clinical trials in NTUH. There were 12 females and 10 males, with an age distribution Of 62.5 +/- 10.4 years. The body mass index was 24.8 +/- 4. 0 kg/m(2). Physical Status (American Society of Anesthesiology classification) was class I in 12, class 11 In eight, and class I I I in two patients. Tumor size was 44 .0 + /- 12.0 mill in diameter. Two patients were in pathologic TNM stage 1, 14 in stage 11, and six in stage III . The operation time was 214.0 +/- 28.4 min. Blood loss was 54.0 +/- 14.0 ml. Because the tumour Specimen was retrieved from a perineal wound, the five 5 to 12 mm working ports Constituted the abdominal wound. There were no major complications. However, wound infection of port sites was detected in one patient. The patients had a quick convalescence, as evaluated by the length of postoperative ileus (48.0 +/- 12.0 h), length of hospitalization (8.0 +/- 2.0 days), and degree of postoperative pain (3.5 +/- 0.5 visual analogue scale). Return to partial activity, full activity, and work was 2.0 +/- 0. 5 4.0 +/- 0.8. and 6.0 +/- 0.5 weeks. respectively. The number of cleared lymph nodes was 14.0 2.0. During follow-up (median. IS months; range. 6- 30), lung metastasis and local pelvic recurrence developed in one and two patients, respectively. Besides the expenses covered by the National Bureau of Health Insurance of Taiwan , the additional payment by patients undergoing laparoscopic procedures was NT $24,000 +/- 3000 (1 U.S. dollar = 32 NTS) . Conclusions: In our clinical setting, laparoscopic APR can be performed With good technical efficiency, quick functional recovery, and mild disability. The short-term oncologic results of laparoscopic APR seem to be acceptable, but further long-term follow-Lip for these patients is mandatory to define the oncologic outcomes of this approach.
|Appears in Collections:||醫學系|
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