Laparoscopic Rectal Cancer Surgery At A Low Volume Center in Gujarat

Dr. SACHIN KADAM; Dr. JIGNESH SHAH; Dr. TEJASWINI KADAM; Dr. HARDIK ASTIK

Volume : X, Issue : VI, June - 2020

Laparoscopic Rectal Cancer Surgery At A Low Volume Center in Gujarat

Dr. Sachin Kadam, Dr. Jignesh Shah, Dr. Tejaswini Kadam, Dr. Hardik Astik

Abstract :

INTRODUCTION: Laparoscopic surgery for rectal cancer is now practiced widely and it has proven short–term benefits for patient recovery. At the beginning of the laparoscopic era, some concerns were raised regarding the oncological outcome of this approach in the treatment of rectal cancer. However, data from randomized trials and meta–analyses have established that laparoscopic rectal surgery is at least equivalent to open surgery. The short–term benefits of laparoscopic surgery includes less post–operative pain, earlier restoration of bowel function, early mobilisation, shorter hospital stay, less morbidity from blood loss , respiratory complications, wound infections, incisional hernias. Still worldwide there is hesitancy for performing laparoscopy surgery for rectal cancers as compared to colon cancers because there is always a fear of circumferential resected margin positivity. MATERIALS & METHODS: It is a retrospective study of 25 cases of rectal cancer who underwent laparoscopic surgeries (Abdomino–perineal resection (APR) , Low anterior resection (LAR), Anterior resection (AR) during the period from January 2009 to December 2011 at Government Medical College and New Civil Hospital, Surat, Gujarat, India. These patients were followed till December 2015. The purpose of this study was to know the role of laparoscopic surgery in rectal malignancies and also morbidity and mortality associated with this surgery. Patients with biopsy proven and operable rectal cancers were included in the study. Patients with locally advanced and metastatic rectal cancers and also any patient died of any other cause and not followed were excluded. Histopthology reports were collected on 7th or 8th postoperative day and according to the report adjuvant treatment was given in Lion’s Cancer Detection Centre (LCDC) which is attached to new civil hospital ,Surat. RESULTS: In our study, the males outnumbered females in the ratio of 1.7:1. The most common age group involved is 51–60yrs (48%). There was no significant post operative morbidity except wound infection [2 cases (8%)] , hypokalemia [2cases (8%) , nausea & vomiting [3cases(12%)]. Lymph nodes were found positive in 7 (28% ) cases. No re–exploration was required in any case. The mean blood loss was around 162.5ml and average duration of operative time was 3.36 hours. During follow up 3 patients had recurrences. Two patients, who had undergone APR and LAR respectively, had developed unresectable pelvic recurrences. Both had received palliative chemotherapy after diagnosed with recurrence . One patient had recurrence at anastomotic site post AR surgery. Patient was operated and recurrence site excised and end colostomy done. But patient’s general condition was not good so no adjuvant treatment given and only supportive care was advised. CONCLUSION: There are still more important issues including long term oncological outcome for advanced colorectal cancer, cost effectiveness & the impact on quality of life of patients with colorectal cancer. This study suggests that laparoscopic resection of colorectal cancer is safe and effective procedure of choice in selected patients. Morbidity and mortality are in acceptable limits.