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News Asia Pacific

A new study by Australian researchers has found that laparoscopic surgery may not be the best option for the removal of rectal tumours. (Photograph: nimon/Shutterstock)
0 Comments Oct 8, 2015 | News Asia Pacific

Less-invasive surgery may not be best option for rectal cancer

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SYDNEY, Australia: A new study by Australian researchers has compared open surgery and laparoscope-assisted keyhole surgery in order to assess which procedure is more successful in the removal of rectal tumours. According to the researchers, concerns remain about the applicability of minimally invasive surgery to rectal cancer and more research is needed to establish the case for the routine use of laparoscopic surgery in this area.

The objective of the multicentre Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT) involving 475 patients with T1–T3 rectal tumours was to assess whether laparoscopic surgery was similar to—or no worse than—open surgery in terms of the successful removal of all of the rectal cancer. Ultimately, the case for recommending the routine use of laparoscopic surgery for such patients will be based on the long-term outcomes regarding recurrence and survival associated with each procedure.

Advances in laparoscopic technology since the 1990s have spurred the adoption of this operative approach to diseases of the rectum. Four international trials have reported no inferiority for laparoscopic surgery for colon cancer in terms of safety, and length of hospital stay and survival, as well as some advantages in terms of morbidity.

However, concerns remain about the applicability of minimally invasive surgery to rectal cancer (the last 15 cm of the bowel within the pelvis) based on a randomised control trial comparison of laparoscopic versus conventional open surgery reporting that the laparoscopic group had a higher positive rate of involvement of the resection margin.

To this point, there has been little definitive evidence to guide surgeons about the safety and efficacy of laparoscopic versus open resection regarding pathological outcomes in rectal cancer. ALaCaRT, conducted by colorectal surgeons in Australia and New Zealand working with the Australasian Gastro-Intestinal Trials Group (AGITG), has now reported some key findings on the rates of successful surgery and postoperative complications. This was based on surgical and tumour-related outcomes measures.

According to the study, successful resection was achieved in 82 per cent of the laparoscopic surgery group compared with 89 per cent of the open surgery group. The circumferential resection margin was clear in 93 per cent of patients in the laparoscopic surgery group and 97 per cent of patients in the open surgery group. The distal margin was clear in 99 per cent of patients in both groups. Complete total mesorectal excision was achieved in 87 per cent of patients in the laparoscopic surgery group and 92 per cent of patients in the open surgery group. Nine per cent of patients allocated to laparoscopic surgery had their operation converted to open surgery.

“The ALaCaRT study is an important next step in analysing our approach to treating rectal cancer with laparoscopic surgery,” said the study’s lead investigator, Dr Andrew Stevenson from the NHMRC Clinical Trials Centre at the University of Sydney. “The results of surgery performed by members of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) in this trial were excellent but we need to wait longer and get further results to understand the best way to use laparoscopic procedures, and to determine whether this is something suitable for all patients or considered with more caution in patients who are difficult to operate on.”

“The important clinical trial research the AGITG conducts in collaboration with the NHMRC Clinical Trials Centre at the University of Sydney is demonstrated by the results of the ALaCaRT trial which has just been published in The Journal of the American Medical Association,” said Associate Professor Tim Price, Chair of AGITG. “It is through collaborative efforts in clinical trial research that we will make a difference in the lives of people with gastro-intestinal cancer.”

According to Prof. John Simes, Director of the NHMRC Clinical Trials Centre, who oversaw the trial conduct, the study offers an excellent example of ensuring optimal care for cancer patients based on a well-conducted trial. “It is a credit to the surgeons, clinical research team and particularly the patients who participated in the trial that we will be well placed to improve future practice,” he said.

The study, titled “Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer. The ALaCaRT randomized clinical trial”, was published online on 6 October in the Journal of the American Medical Association.

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