Laparoscopic vs. Open Resection in Rectal CancerWritten by Ivo Mitsiev at in "Minimally Invasive Surgery" and also in "Surgical Oncology", "Colorectal Surgery".
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:
Using the same protocol, another study was published in the same issue of JAMA by Dr. Stevenson from Brisbane, Australia:
Both studies show that the laparoscopic approach is inferior to the open one in terms of:
- composite of circumferential radial margin greater than 1 mm,
- distal margin without tumor, and
- completeness of total mesorectal excision.
Both Dr. Fleshman and Dr. Stevenson presented their studies on Monday, May 2, 2016 at the ASCRS Annual Scientific Meeting.
Dr. Fleshman was kind enough to agree giving an interview with BTK.