Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial

Authors

  • Sergio Eduardo Alonso Araujo University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Afonso Henrique da Silva e Sousa Jr University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Fábio Guilherme Caserta Marysael de Campos University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Angelita Habr-Gama University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Rodrigo Blanco Dumarco University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Pedro Paulo de Paris Caravatto University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Sergio Carlos Nahas University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • José Hyppólito da Silva University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Desidério Roberto Kiss University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department
  • Joaquim José Gama-Rodrigues University of São Paulo; Faculty of Medicine; Hospital das Clínicas; Digestive Surgery Department

DOI:

https://doi.org/10.1590/S0041-87812003000300002

Keywords:

Rectal cancer, Rectum, Laparoscopic resection, Abdominoperineal amputation

Abstract

OBJECTIVE: The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation. METHOD: Twenty eight patients with distal rectal adenocarcinoma were randomized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospectively. Thirteen underwent laparoscopic abdominoperineal resection and 15 conventional approach. RESULTS: There was no significant difference (p<0,05) between the two studied groups regarding: gender, age, body mass index, patients with previous abdominal surgeries, intra and post operative complications, need for blood transfusion, hospital stay after surgery, length of resected segment and pathological staging. Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach (p=0.04). Mean anesthesia duration was shorter (p=0.03) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes, respectively. There was no need for conversion to open approach in this series. After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery, local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group. CONCLUSIONS: We conclude that laparoscopic abdominoperineal resection is feasible, similar to conventional approach concerning surgery duration, intra operative morbidity, blood requirements and post operative morbidity. Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer.

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Published

2003-01-01

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Section

Original Articles

How to Cite

Araujo, S. E. A., Sousa Jr, A. H. da S. e, Campos, F. G. C. M. de, Habr-Gama, A., Dumarco, R. B., Caravatto, P. P. de P., Nahas, S. C., Silva, J. H. da, Kiss, D. R., & Gama-Rodrigues, J. J. (2003). Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial . Revista Do Hospital Das Clínicas, 58(3), 133-140. https://doi.org/10.1590/S0041-87812003000300002