Laparoscopic Management Of Rectal Tumors in Developing Countries

Aims: The laparoscopic surgery for rectal cancer is much more challenging than laparoscopic colonic surgeries due to limited space in pelvis. However its feasibility and safety has been established in many randomised and non-randomised studies. The aim of our study was to evaluate the short term outcomes of laparoscopic approach for rectal cancer surgeries in developing countries. Methods: 30 patients were included in our prospective observational study out of which 14 underwent laparoscopic and 16 underwent open surgeries for rectal cancer. Short term outcomes in both groups were recorded and analysed. Conversions were excluded from the study. Findings: The intra operative blood loss (146.7 + 25.3 ml in laparoscopic group (LAP) and 353.8 + 32.2 ml in open surgical (OS); p-value < 0.001) , requirement of analgesia (4.1 + 2.3 doses in LAP and 8.4 + 3.1 doses in OS group: p-value < 0.0002) , time of resumption of intestinal function (i.e. appreciation of flatus after 46.8 + 6.2 hours in LAP group and 82.9 + 8.1 hours in OS group; p-value < 0.001) and post-operative hospital stay(6.5 + 1.3 days in LAP group and 9.1 + 2.1 days in OS group; p-value < 0.0002) were relatively less in laparoscopic group. The early post-operative complications ( p-value=0.260) and lymph node yield (13.6 + 2.5 in LAP and 14.3+ 2.1 in OS group; p-value=0.412) were comparable in the two groups. However, operative time was 205.5 + 21 .3 minutes in LAP group and 151.1 + 17.8 minutes in OS group ( p-value < 0.001). No short term mortality was noted. Interpretation: Laparoscopic surgery for rectal tumors is feasible, oncologically safe and has better short term outcomes. Keywords: Colorectal Carcinoma; Rectal Cancer; Low Anterior Resection; Abdominoperineal Resection; Total Mesorectal Excisio