| Hand-assisted laparoscopic surgery versus open
surgery in rectal cancer patients |
| Chang Jong Kim, Bo-Young Oh, Kyoung Sook Hong, Soon Sup Chung, Kwang Ho Kim |
| Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea |
| 직장암 환자에서 수부보조 복강경 수술과 개복술의 비교 |
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김창종, 오보영, 홍경숙, 정순섭, 김광호 |
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이화여자대학교 의학전문대학원 외과학교실 |
| Corresponding Author:
Kwang Ho Kim ,Tel: +82-2-2650-5585, Fax: +82-2-2644-7984, Email: eastgate@ewha.ac.kr |
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Received: June 11, 2012; Accepted: June 18, 2012. |
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| ABSTRACT |
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Purpose : Laparoscopic surgery has been shown to be useful modality to be compared with conventional open
surgery. However, it has been raised several limitations such as absence of tactile sense, long operative time,
technically complexity, and limited operative field. Hand-assisted laparoscopic surgery (HALS) has been proposed
as an alternative to these limitations of laparoscopic surgery. The aim of this study is to compare HALS with
conventional open surgery(OS) in rectal cancer patients.
Methods : We reviewed 36 rectal cancer patients who underwent operation between Jan 2009 and Oct 2011, retrospectively.
Patients were diagnosed with rectal cancer and underwent HALS AR/LAR or open AR/LAR by the same
surgical team. Patients were excluded from this study when visceral peritoneum was invaded (T4), the largest lesion
was bigger than 5 cm, there were synchronous metastasis of other organs other than the rectum, resection of other
organs in addition to rectum were accompanied during operation, and HALS was converted to OS. Patients were
classified into two groups with either HALS or OS. We compared perioperative outcomes of each group.
Results : Out of 36 patients, 14 underwent HALS AR/LAR and 22 underwent open AR/LAR. There was no significant
difference between these two groups in age, sex, BMI, and comorbidities. HALS group had significantly longer
operative time than OS group (243.9 min vs. 201.1 min, p= 0.014). HALS group had significantly shorter skin
incision (7.5 cm vs. 19.5 cm, p=0.000) and less estimated blood loss (112.0 ml vs. 342.3 ml, p=0.001) than OS group.
In histopathologic reports, HALS group had significantly earlier stage (1.5 vs. 2.3, p=0.009) than OS group, but
there was no significant difference in number of harvested lymph nodes and length of resection margin. In postoperative
course, there was no significant difference in date of first gas out, date of starting diet, number of
parenteral opioid analgesics administered, and amount of RBC transfused, but HALS group was shown shorter
length of hospital stay (10.4 days vs. 13.3 days, p=0.011) than OS group. Also post-operative morbidity or mortality
did not shown significant differences between the two groups.
Conclusion : This study showed that HALS AR/LAR seems to be minimally invasive and oncologically feasible.
Therefore, it is also useful alternative modality as laparoscopic surgery or open surgery in rectal cancer patients. |
| Keywords:
hand-assisted laparoscopic surgery | laparoscopic colectomy | open colectomy | rectal cancer |
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