Surgery Blog for Surgeons

Laparoscopic vs. Open Resection in Rectal Cancer

Open low anterior resection (LAR) and abdomino-perineal resections (APR) are not easy procedures, esp. in tight male pelvises. The laparoscopic approach gave us a tool dramatically improving the exposure and making the whole mesorectal excision significantly easier. As frequently in situations like that, we were quite hopeful (and meanwhile biased towards believeing) that the advantages in the laparoscopic LAR and APR would translate in better oncological outcomes.

Dr. Fleshman (Dallas, Texas) was one of the most vocal proponents of the laparoscopic approach and wanted to prove it. He recently published a very well designed study:

Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes
The ACOSOG Z6051 Randomized Clinical Trial

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Laparoscopically assisted vs. open colectomy for colon cancer

This is a somehow old (mid 2004) but nevertheless important multicenter trial which aroused my interest due to the fact that I do laparoscopically (hand)assisted colectomies.

The conclusion is:

...the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.

Though, "no advantage of laparoscopically assisted surgery was evident with respect to either all stages of cancer or high-risk subgroups".

The collecting of data for the trial began 1994. Therefore the new, hand assisted approach in the laparoscopic surgery, could not be considered.

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Detection of tumor DNA in stool samples

A recent publication from the laboratory institute in the University Hospital in Hamburg, Germany discusses a new approach to diagnosing colorectal carcinoma: detection of tumor DNA in stool samples. Here is the abstract of the publication in the german "Aerzteblatt":

Detection of tumour DNA in stool is a new screening approach aimed at improving the early diagnosis of colorectal cancer. DNA from colorectal adenomas or carcinomas can be detected using specific mutations or methylation patterns. Altered DNA can in principle be detected in a high excess of normal DNA with high sensitivity, but low cost routine screening assays have yet to be developed. The combination of markers and methods must be refined to detect early stage tumours reliably. Only a test with high sensitivity could replace colonoscopy as the recommended screening method in the future.