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Laparoscopic TME in rectal cancer – electronic supplementary: op-video
BACKGROUND: Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not...
Autores principales: | , , , , |
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Formato: | Texto |
Lenguaje: | English |
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Springer-Verlag
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814039/ https://www.ncbi.nlm.nih.gov/pubmed/20076969 http://dx.doi.org/10.1007/s00423-009-0556-y |
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author | Fürst, Alois Schwandner, Oliver Heiligensetzer, Arthur Iesalnieks, Igors Agha, Ayman |
author_facet | Fürst, Alois Schwandner, Oliver Heiligensetzer, Arthur Iesalnieks, Igors Agha, Ayman |
author_sort | Fürst, Alois |
collection | PubMed |
description | BACKGROUND: Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not available. Compared to conventional surgery, the laparoscopic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss (Leung et al., Lancet 363:1187–1192, 2004; Braga et al., Dis Colon Rectum 48:217–223, 2005; Jayne et al., J Clin Oncol 25:3061–3068, 2007; Agha et al., Surg Endosc 22:2229–2237, 2008). METHODS: The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. With regard of the oncological dimension, the laparoscopic TME technique is not different compared to the open procedure. However, a standardized laparoscopic step-by-step procedure may simplify the operation and can reduce operation time. RESULTS: There are no studies available which compare different types of TME procedures. Most surgeons start the operation left laterally mobilizing the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier, and the identification of the left ureter may be simplified. After multiple workshops and extensive discussion with national and international experts, we developed a standardized laparoscopic “10 step TME procedure.” Reviewing the results of laparoscopic TME the studies do not allow firm conclusions as to the questions of whether the safety and efficacy of laparoscopic TME is equal or superior to open TME (Breukink et al. 2006). Actually, we are waiting for large prospective randomized studies comparing laparoscopic TME with the traditional open procedure (Bonjer et al., Dan Med Bull 56:89–91, 2009). CONCLUSION: Laparoscopic TME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer based on evidence mainly from nonrandomized studies (Breukink et al. 5). In nearly all published studies, the efficacy and technical feasibility of laparoscopic surgery for rectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized laparoscopic TME technique can be strongly recommended. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00423-009-0556-y) contains supplementary material, which is available to authorized users. |
format | Text |
id | pubmed-2814039 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
spelling | pubmed-28140392010-02-13 Laparoscopic TME in rectal cancer – electronic supplementary: op-video Fürst, Alois Schwandner, Oliver Heiligensetzer, Arthur Iesalnieks, Igors Agha, Ayman Langenbecks Arch Surg How to Do It BACKGROUND: Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not available. Compared to conventional surgery, the laparoscopic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss (Leung et al., Lancet 363:1187–1192, 2004; Braga et al., Dis Colon Rectum 48:217–223, 2005; Jayne et al., J Clin Oncol 25:3061–3068, 2007; Agha et al., Surg Endosc 22:2229–2237, 2008). METHODS: The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. With regard of the oncological dimension, the laparoscopic TME technique is not different compared to the open procedure. However, a standardized laparoscopic step-by-step procedure may simplify the operation and can reduce operation time. RESULTS: There are no studies available which compare different types of TME procedures. Most surgeons start the operation left laterally mobilizing the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier, and the identification of the left ureter may be simplified. After multiple workshops and extensive discussion with national and international experts, we developed a standardized laparoscopic “10 step TME procedure.” Reviewing the results of laparoscopic TME the studies do not allow firm conclusions as to the questions of whether the safety and efficacy of laparoscopic TME is equal or superior to open TME (Breukink et al. 2006). Actually, we are waiting for large prospective randomized studies comparing laparoscopic TME with the traditional open procedure (Bonjer et al., Dan Med Bull 56:89–91, 2009). CONCLUSION: Laparoscopic TME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer based on evidence mainly from nonrandomized studies (Breukink et al. 5). In nearly all published studies, the efficacy and technical feasibility of laparoscopic surgery for rectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized laparoscopic TME technique can be strongly recommended. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00423-009-0556-y) contains supplementary material, which is available to authorized users. Springer-Verlag 2010-01-15 2010 /pmc/articles/PMC2814039/ /pubmed/20076969 http://dx.doi.org/10.1007/s00423-009-0556-y Text en © The Author(s) 2010 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. |
spellingShingle | How to Do It Fürst, Alois Schwandner, Oliver Heiligensetzer, Arthur Iesalnieks, Igors Agha, Ayman Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title | Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title_full | Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title_fullStr | Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title_full_unstemmed | Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title_short | Laparoscopic TME in rectal cancer – electronic supplementary: op-video |
title_sort | laparoscopic tme in rectal cancer – electronic supplementary: op-video |
topic | How to Do It |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814039/ https://www.ncbi.nlm.nih.gov/pubmed/20076969 http://dx.doi.org/10.1007/s00423-009-0556-y |
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