Klinik Araştırma
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LAPAROSKOPİK ve AÇIK YÖNTEM İLE KOLOREKTAL CERRAHİ YAPILAN HASTALARIN KARŞILAŞTIRILMASI

Yıl 2022, Cilt: 29 Sayı: 4, 567 - 574, 27.12.2022
https://doi.org/10.17343/sdutfd.1108081

Öz

Amaç
Laparoskopik kolorektal cerrahi günümüzde birçok
merkezde yaygın olarak kullanılan bir yöntem halini
almıştır. Çalışmamızda laparoskopik ve açık kolorektal
cerrahi uygulanan olgularda postoperatif klinik ve
onkolojik sonuçların karşılaştırılması ve literatür ile kıyaslanması
amaçlanmıştır.
Gereç ve Yöntem
Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi
genel cerrahi kliniğinde Ocak 2012 ile Aralık
2018 tarihleri arasında kolorektal cerrahi uygulanan
hastaların verileri retrospektif olarak incelenmiştir.
Bulgular
Çalışmamıza 438’i (%80,5) açık, 73’ü (%13,4) laparoskopik,
33’ü (%6,1) konversiyon ile rezeksiyon
uygulanan toplam 544 hasta dahil edildi. Seride acil
opere edilen vaka sayısı 158 (%29,0), elektif vaka sayısı
386’dır (%71,0). Toplam 156 (%28,7) postoperatif
komplikasyon saptanmış olup, gruplara göre değerlendirildiğinde;
laparoskopik cerrahi grubunda postoperatif
komplikasyon 20 (%27,4), açık cerrahi grubunda
126 (%28,8), konversiyon grubunda 10 (%30,3)
postoperatif komplikasyon saptanmıştır. Rektum
kanserlerinde ortalama çıkarılan lenf nodu sayıları
açık prosedürde 19,0±9,7, laparoskopik prosedürde
22,3±11,6’ dir (p:0,198). Laparoskopik ve açık cerrahi
grubundaki rektum kanseri olgularında sırasıyla 1
(%2,3) ve 8 (%5,9) hastada pozitif çevresel cerrahi
sınır saptanmıştır (p:0,456). Ortalama distal cerrahi
sınır açık grupta 45,1±39,8, laparoskopik grupta
41,1±37,7 ’dir (p:0,608).
Sonuç
Laparoskopik kolorektal kanser cerrahisi klinik ve onkolojik
sonuçlar yönünden açık prosedür ile karşılaştırılabilir
sonuçlara sahiptir. Minimal invaziv cerrahinin
bilinen birçok avantajı göz önüne alındığında laparoskopik
cerrahi muhtemelen kolon kanseri için standart
tedavi haline gelecektir.

Kaynakça

  • 1. Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Translational Oncology 2021;14(10):101174.
  • 2. van der Pas M, Haglind E, Cuesta M, Fürst A, Lacy A, Hop W et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet Oncology 2013;14(3):210-218.
  • 3.Kim W, Kim H, Han S, Kim M, Hyung W, Ryu S et al. Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer. Annals of Surgery 2016;263(1):28-35.
  • 4. Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surgical Endoscopy 2012;27(5):1695-1705.
  • 5. McCombie A, Frizelle F, Bagshaw P, Frampton C, Hewett P, McMurrick P et al. The ALCCaS Trial: A Randomized Controlled Trial Comparing Quality of Life Following Laparoscopic Versus Open Colectomy for Colon Cancer. Diseases of the Colon & Rectum 2018;61(10):1156-1162.
  • 6. Wu J, Birnbaum E, Fleshman J. Early experience with laparoscopic abdominoperineal resection. Surgical Endoscopy 1997;11(5):449-455.
  • 7. Wu W, Sun Y, Hua Y, Shen L. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study. World Journal of Gastroenterology 2004;10(8):1167.
  • 8. Lujan J, Valero G, HernandezQ, Sanchez A, Frutos M D, Parrilla P. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 2009;96(9):982-989.
  • 9. Dural A, Keskin M, Balik E, Akici M, Kunduz E, Yamaner S et al. The Role of the Laparoscopy on Circumferential Resection Margin Positivity in Patients With Rectal Cancer. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2015;25(2):129-137.
  • 10.Green B, Marshall H, Collinson F, P Quirke, P Guillou, D G Jayne et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer British Journal of Surgery 2013;100(1):75-82.
  • 11. Stevenson A, Solomon M, Lumley J, Hewett P, Clouston A, Gebski V et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer. JAMA 2015;314(13):1356.
  • 12. Fleshman J, Branda M, Sargent D, Boller A, George V, Abbas M et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes. JAMA 2015;314(13):1346.
  • 13. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F et al. Short-Term Surgical Outcomes From a Randomized Controlled Trial to Evaluate Laparoscopic and Open D3 Dissection for Stage II/III Colon Cancer. Annals of Surgery 2014;260(1):23-30.
  • 14. Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Martani C et al. Metabolic and Functional Results After Laparoscopic Colorectal Surgery. Diseases of the Colon & Rectum 2002;45(8):1070-1077.
  • 15. Aziz O, Constantinides V, Tekkis P, Athanasiou T, Purkayastha S, Paraskeva P et al. Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis. Annals of Surgical Oncology 2006;13(3):413-424.
  • 16. Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. The Lancet Oncology 2005;6(7):477-484.
  • 17. Tjandra J, Chan M. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Disease 2006;8(5):375-388.
  • 18. COST study group. A comparison of laparoscopically assisted and open colectomy for colon cancer. New England Journal of Medicine 2004;350(20):2050–9.
  • 19. Deijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene P-PLO, Lange JF et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surgical Endoscopy 2017;31(6):2607–15.
  • 20. Draeger T, Völkel V, Gerken M, Klinkhammer-Schalke M, Fürst A. Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a Southern German district. Surgical Endoscopy 2018;32(10):4096–104.
  • 21. Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA. Laparoscopically assisted colon resection for colon carcinoma Perioperative results and long-term outcome. Surgical Endoscopy 2000;14(11):1062–6.
  • 22. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. The Lancet 2002;359(9325):2224–9
  • 23. Leung KL, Meng WCS, Lee JFY, Thung KH, Lai PBS, Lau WY. Laparoscopic-assisted resection of right-sided colonic carcinoma: A case-control study. Journal of Surgical Oncology 1999;71(2):97–100.
  • 24. Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM, et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surgical Endoscopy 1995;9(10).
  • 25. Leung KL, Yiu RYC, Lai PBS, Lee JFY, Thung KH, Lau WY. Laparoscopic-assisted resection of colorectal carcinoma. Diseases of the Colon & Rectum 1999;42(3):327–32.
  • 26. Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. The lancet Gastroenterology & hepatology 2017;2(4):261-268.
  • 27. Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. The Lancet Oncology 2014;15(7):767–74.
  • 28. Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW. Laparoscopic vs Open Resection for Patients With Rectal Cancer: Comparison of Perioperative Outcomes and Long-Term Survival. Diseases of the Colon & Rectum 2011;54(1):6–14.
  • 29. Kellokumpu IH, Kairaluoma MI, Nuorva KP, Kautiainen HJ, Jantunen IT. Short- and Long-term Outcome Following Laparoscopic Versus Open Resection for Carcinoma of the Rectum in the Multimodal Setting. Diseases of the Colon & Rectum 2012;55(8):854–63.
  • 30. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: A cochrane systematic review of randomised controlled trials. Cancer Treatment Reviews 2008;34(6):498–504.
  • 31. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. The Lancet 2005;365(9472):1718–26.
  • 32. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD et al. Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer. Annals of Surgery 2019;269(4):596–602.

COMPARISON OF PATIENTS TREATED WITH LAPAROSCOPIC AND OPEN COLORECTAL SURGERY

Yıl 2022, Cilt: 29 Sayı: 4, 567 - 574, 27.12.2022
https://doi.org/10.17343/sdutfd.1108081

Öz

Objective
Laparoscopic colorectal surgery has become a widely
used method in many centers today. In our study,
it was aimed to compare the postoperative clinical
and oncological results in patients who underwent
laparoscopic and open colorectal surgery and to
compare them with the literature.
Material and Method
The data of patients who underwent colorectal
surgery between January 2012 and December 2018
at the Dışkapı Yıldırım Beyazıt Training and Research
Hospital General Surgery clinic were analyzed
retrospectively.
Results
A total of 544 patients were included in our study,
of which 438 (80.5%) underwent open resection, 73
(13.4%) laparoscopic, 33 (6.1%) underwent resection
with conversion. In the series, the number of cases
that were operated urgently was 158 (29.0%), and the
number of elective cases was 386 (71.0%). A total
of 156 (28.7%) postoperative complications were
detected. When evaluated according to the groups;
There were 20 (27.4%) postoperative complications
in the laparoscopic surgery group, 126 (28.8%) in the
open surgery group, and 10 (30.3%) in the conversion
group. The mean number of lymph nodes removed in
rectal cancers is 19.0±9.7 in the open procedure and
22.3±11.6 in the laparoscopic procedure (p: 0.198). A
positive circumferential surgical margin was found in 1
(2.3%) and 8 (5.9%) patients with rectal cancer in the
laparoscopic and open surgery groups, respectively
(p: 0.456). The mean distal surgical margin was
45.1±39.8 mm in the open group and 41.1±37.7 mm
in the laparoscopic group (p: 0.608).
Conclusion
Laparoscopic colorectal cancer surgery has
comparable clinical and oncological outcomes to the
open procedure. Given the many known advantages
of minimally invasive surgery, laparoscopic surgery
will likely become the standard treatment for colon
cancer.

Kaynakça

  • 1. Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Translational Oncology 2021;14(10):101174.
  • 2. van der Pas M, Haglind E, Cuesta M, Fürst A, Lacy A, Hop W et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. The Lancet Oncology 2013;14(3):210-218.
  • 3.Kim W, Kim H, Han S, Kim M, Hyung W, Ryu S et al. Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer. Annals of Surgery 2016;263(1):28-35.
  • 4. Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Watanabe M et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surgical Endoscopy 2012;27(5):1695-1705.
  • 5. McCombie A, Frizelle F, Bagshaw P, Frampton C, Hewett P, McMurrick P et al. The ALCCaS Trial: A Randomized Controlled Trial Comparing Quality of Life Following Laparoscopic Versus Open Colectomy for Colon Cancer. Diseases of the Colon & Rectum 2018;61(10):1156-1162.
  • 6. Wu J, Birnbaum E, Fleshman J. Early experience with laparoscopic abdominoperineal resection. Surgical Endoscopy 1997;11(5):449-455.
  • 7. Wu W, Sun Y, Hua Y, Shen L. Laparoscopic versus conventional open resection of rectal carcinoma: A clinical comparative study. World Journal of Gastroenterology 2004;10(8):1167.
  • 8. Lujan J, Valero G, HernandezQ, Sanchez A, Frutos M D, Parrilla P. Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 2009;96(9):982-989.
  • 9. Dural A, Keskin M, Balik E, Akici M, Kunduz E, Yamaner S et al. The Role of the Laparoscopy on Circumferential Resection Margin Positivity in Patients With Rectal Cancer. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2015;25(2):129-137.
  • 10.Green B, Marshall H, Collinson F, P Quirke, P Guillou, D G Jayne et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer British Journal of Surgery 2013;100(1):75-82.
  • 11. Stevenson A, Solomon M, Lumley J, Hewett P, Clouston A, Gebski V et al. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer. JAMA 2015;314(13):1356.
  • 12. Fleshman J, Branda M, Sargent D, Boller A, George V, Abbas M et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes. JAMA 2015;314(13):1346.
  • 13. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F et al. Short-Term Surgical Outcomes From a Randomized Controlled Trial to Evaluate Laparoscopic and Open D3 Dissection for Stage II/III Colon Cancer. Annals of Surgery 2014;260(1):23-30.
  • 14. Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Martani C et al. Metabolic and Functional Results After Laparoscopic Colorectal Surgery. Diseases of the Colon & Rectum 2002;45(8):1070-1077.
  • 15. Aziz O, Constantinides V, Tekkis P, Athanasiou T, Purkayastha S, Paraskeva P et al. Laparoscopic Versus Open Surgery for Rectal Cancer: A Meta-Analysis. Annals of Surgical Oncology 2006;13(3):413-424.
  • 16. Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. The Lancet Oncology 2005;6(7):477-484.
  • 17. Tjandra J, Chan M. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Disease 2006;8(5):375-388.
  • 18. COST study group. A comparison of laparoscopically assisted and open colectomy for colon cancer. New England Journal of Medicine 2004;350(20):2050–9.
  • 19. Deijen CL, Vasmel JE, de Lange-de Klerk ESM, Cuesta MA, Coene P-PLO, Lange JF et al. Ten-year outcomes of a randomised trial of laparoscopic versus open surgery for colon cancer. Surgical Endoscopy 2017;31(6):2607–15.
  • 20. Draeger T, Völkel V, Gerken M, Klinkhammer-Schalke M, Fürst A. Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a Southern German district. Surgical Endoscopy 2018;32(10):4096–104.
  • 21. Curet MJ, Putrakul K, Pitcher DE, Josloff RK, Zucker KA. Laparoscopically assisted colon resection for colon carcinoma Perioperative results and long-term outcome. Surgical Endoscopy 2000;14(11):1062–6.
  • 22. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. The Lancet 2002;359(9325):2224–9
  • 23. Leung KL, Meng WCS, Lee JFY, Thung KH, Lai PBS, Lau WY. Laparoscopic-assisted resection of right-sided colonic carcinoma: A case-control study. Journal of Surgical Oncology 1999;71(2):97–100.
  • 24. Lacy AM, Garcia-Valdecasas JC, Pique JM, Delgado S, Campo E, Bordas JM, et al. Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surgical Endoscopy 1995;9(10).
  • 25. Leung KL, Yiu RYC, Lai PBS, Lee JFY, Thung KH, Lau WY. Laparoscopic-assisted resection of colorectal carcinoma. Diseases of the Colon & Rectum 1999;42(3):327–32.
  • 26. Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. The lancet Gastroenterology & hepatology 2017;2(4):261-268.
  • 27. Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. The Lancet Oncology 2014;15(7):767–74.
  • 28. Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW. Laparoscopic vs Open Resection for Patients With Rectal Cancer: Comparison of Perioperative Outcomes and Long-Term Survival. Diseases of the Colon & Rectum 2011;54(1):6–14.
  • 29. Kellokumpu IH, Kairaluoma MI, Nuorva KP, Kautiainen HJ, Jantunen IT. Short- and Long-term Outcome Following Laparoscopic Versus Open Resection for Carcinoma of the Rectum in the Multimodal Setting. Diseases of the Colon & Rectum 2012;55(8):854–63.
  • 30. Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J. Long-term outcome of laparoscopic surgery for colorectal cancer: A cochrane systematic review of randomised controlled trials. Cancer Treatment Reviews 2008;34(6):498–504.
  • 31. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. The Lancet 2005;365(9472):1718–26.
  • 32. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD et al. Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer. Annals of Surgery 2019;269(4):596–602.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Cerrahi
Bölüm Araştırma Makaleleri
Yazarlar

Selim Tamam 0000-0002-2924-1874

Zafer Ergül 0000-0002-0310-9218

Serhat Tokgöz 0000-0003-2716-6222

İsmail Oskay Kaya 0000-0002-1864-896X

Yayımlanma Tarihi 27 Aralık 2022
Gönderilme Tarihi 1 Mayıs 2022
Kabul Tarihi 24 Ekim 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 29 Sayı: 4

Kaynak Göster

Vancouver Tamam S, Ergül Z, Tokgöz S, Kaya İO. LAPAROSKOPİK ve AÇIK YÖNTEM İLE KOLOREKTAL CERRAHİ YAPILAN HASTALARIN KARŞILAŞTIRILMASI. SDÜ Tıp Fak Derg. 2022;29(4):567-74.

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