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KMID : 1188520120080010050
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Korean Journal of Clinical Oncology
2012 Volume.8 No. 1 p.50 ~ p.56
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Hand-assisted laparoscopic surgery versus open surgery in rectal cancer patients
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Kim Chang-Jong
Oh Bo-Young
Hong Kyung-Sook
Lee Ryung-Ah
Chung Soon-Sup
Kim Kwang-Ho
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Abstract
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Purpose: Laparoscopic surgery has been shown to be useful modality to be compared with conventional open surgery. However, it has been raised several limitations such as absence of tactile sense, long operative time, technically complexity, and limited operative field. Hand-assisted laparoscopic surgery (HALS) has been proposed as an alternative to these limitations of laparoscopic surgery. The aim of this study is to compare HALS with conventional open surgery(OS) in rectal cancer patients.
Methods: We reviewed 36 rectal cancer patients who underwent operation between Jan 2009 and Oct 2011, retrospectively. Patients were diagnosed with rectal cancer and underwent HALS AR/LAR or open AR/LAR by the same surgical team. Patients were excluded from this study when visceral peritoneum was invaded (T4), the largest lesion was bigger than 5 ㎝, there were synchronous metastasis of other organs other than the rectum, resection of other organs in addition to rectum were accompanied during operation, and HALS was converted to OS. Patients were classified into two groups with either HALS or OS. We compared perioperative outcomes of each group.
Results: Out of 36 patients, 14 underwent HALS AR/LAR and 22 underwent open AR/LAR. There was no significant difference between these two groups in age, sex, BMI, and comorbidities. HALS group had significantly longer operative time than OS group (243.9 min vs. 201.1 min, p= 0.014). HALS group had significantly shorter skin incision (7.5 ㎝ vs. 19.5 ㎝, p=0.000) and less estimated blood loss (112.0 ㎖ vs. 342.3 ㎖, p=0.001) than OS group. In histopathologic reports, HALS group had significantly earlier stage (1.5 vs. 2.3, p=0.009) than OS group, but there was no significant difference in number of harvested lymph nodes and length of resection margin. In postoperative course, there was no significant difference in date of first gas out, date of starting diet, number of parenteral opioid analgesics administered, and amount of RBC transfused, but HALS group was shown shorter length of hospital stay (10.4 days vs. 13.3 days, p=0.011) than OS group. Also post-operative morbidity or mortality did not shown significant differences between the two groups.
Conclusion: This study showed that HALS AR/LAR seems to be minimally invasive and oncologically feasible. Therefore, it is also useful alternative modality as laparoscopic surgery or open surgery in rectal cancer patients.
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KEYWORD
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hand-assisted laparoscopic surgery, laparoscopic colectomy, open colectomy, rectal cancer
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