Comparative Study On The Radical Resection Of Rectal Carcinoma By Laparoscopy Versus Open Approach

[Objective] : To investigate methods and possibility in radical resection of colorectal carcinoma by laparoscope . To improve the curative effect in radical resection of colorectal carcinoma with laparoscope and reduce the complications.[Methods] : Seventy—five cases were enrolled in this study from May 2002 to Oct 2007, including 33 cases undergoing laparoscopic radical resection(LRR group, 28 Dixon and 5 Miles) and 42 cases undergoing open radical resection (ORR group, 30 Dixons and 12 Miles). There were no obvious clinical differences in two groups. By comparing the two group data in the amount of hemorrhage , operative time, complications , recovery of operation, and hospital expenses, the advantages and possibility in radical resection of rectal carcinoma by laparoscopy can be confirmed. [Results] All cases in radical resection of rectal carcinoma by laparoscopy were successful and only one case converted to open surgery. In LRR group, the average operative time was 200 min(150-300min).The amount of hemorrhage was 100 ml (30 - 400 ml), the time of bowel movement return was 36 hours (24—50h),4 cases developed incision infection, the mean number of lymphnode harvest was 10. 9(4-20), the average hospital stay was 10.8 days(7-19d). In ORR group, the average operative time was 140 min (90-210min), the amount of hemorrhage was 170 ml (80—500 ml ), the time of bowel movement return was 48 hours (36—72h), 4 cases developed incision infection, the mean number of lymphnode harvest was 12. 3(4-19), and the average hospital stay was 14. 5 days(9-22d). There were remarktable differences by comparing the two group data in the amount of hemorrhage, operative time, complications and recovery of operation(P<0.01), however hospital expenses in laparoscopic group was higher than open group (20. 5 thousand yuan RMB vs. 17. 6 thousand yuan RMB, P <0. 05). Following-up time in two groups including 30 cases (90. 9%) in laparoscopic group and 38 cases (90. 5%) in open operation group is 1 to 60 months, average 31 months. The recurrent rate and overall survival rate were 30.0% and 80.0% in LTME group, with no significant diference compared to those in OTME group(28. 5% and 77.8%), (P >0. 05).[Conclusion] 1,The advantage of smaller incision in radical resection of rectal carcinoma by laparoscopy is assured. 2,The radical resection of rectal carcinoma by laparoscopy was safe and feasible.3,The overall recurrent rate and survival rate in laparoscopy group was simillar to open group, this suggest that laparoscopy can get outcome as conventional open approach. 4,The cost-effect analysis remain to further study to firmly verify the advantages of laparoscopy.