Mini-laparotomy effective in rectal cancer surgery

Oct 24 2012

Mini-laparotomy for rectal cancer results in similar outcomes to that of traditional laparotomy, show results from a Chinese center.

Furthermore, the authors' findings suggest the technique could result in faster recovery and fewer complications.

"It could be that mini-laparotomy surgery is the safer and more effective operation for rectal cancer," write Li Li (Sichuan University, China) and colleagues in the World Journal of Gastroenterology.

They compared the outcomes of 410 patients who underwent mini-laparotomy and 1005 patients who underwent traditional laparotomy over an 8-year period. Patients chose the type of surgery they wanted but characteristics were similar between the two groups.

Li and colleagues found that, overall, 5-year survival was similar between the two groups, at 80.6% for mini-laparotomy and 79.4% for traditional laparotomy. In addition, local recurrence did not differ between the two groups at 1 and 5 years, respectively.

The time to first ambulation was significantly shorter in the mini-laparotomy group, at 3.2 days compared with 3.9 days in the traditional laparotomy group. However, the authors say this may be subject to bias. Time to aerofluxus (3.5 vs 4.3 days) and length of hospital stay (6.4 vs 9.7 days) were also significantly shorter in the mini-laparotomy group.

Rates of complications were similar between the two groups. However, patients in the mini-laparotomy group had lower rates of anastomotic leakage, at 0.5% compared with 4.8% in the traditional laparotomy group. These patients also had lower rates of intestinal obstruction, at 2.2% compared with 7.3% in the traditional laparotomy group, which the authors say may be due to less peritoneal manipulation as well as a shorter incision length.

Li and colleagues believe theirs is one of the first reports of mini-laparotomy for rectal cancer, and that while further results from laparoscopic colorectal resection are awaited, mini-laparotomy may have advantages.

"We speculate that the learning curve is lower than that of laparoscopic proctectomy because standard instrumentation, direct vision and tactile feedback are maintained for mini-laparotomy, but not for laparoscopy," they write.

They add that further studies will be needed to confirm their results in bigger populations and by other surgical teams.

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