Outcomes of Surgery for Rectal Cancer after Neoadjuvant Chemoradiation - Comparison between Open & Laparoscopic Surgery.

Ritesh, Tapkire (2010) Outcomes of Surgery for Rectal Cancer after Neoadjuvant Chemoradiation - Comparison between Open & Laparoscopic Surgery. Masters thesis, Cancer Institute (WIA), Chennai.


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BACKGROUND : Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, improved local control & was associated with reduced toxicity although it didn’t improve survival1. Thus preoperative chemoradiotherapy can be considered standard of care for locally advanced rectal cancer. Laparoscopic assisted surgery for colon cancer is as effective as open surgery in the short term & is likely to produce similar long-term outcomes2. However, impaired short-terms outcomes after laparoscopic assisted anterior resection for cancer of rectum do not yet justify its routine use. Furthermore, there is very limited data available on role of laparoscopy surgery for rectal cancer following neoadjuvant chemoradiation. AIMS : 1. To compare laparoscopic & open surgery for rectal cancer after neoadjuvant chemoradiation in terms of acute morbidity. 2. To assess oncological efficacy in terms of nodal yield and circumferential resection margin. MATERIAL AND METHODS : This study is a retrospective study, over a period of 6 years from January 2003 to april 2009 which included 251 patients. 192 patient underwent open surgery (Group I )as compared to 59 in laparoscopic surgery group( Group II). Neoadjuvant treatment was given to 131 patients in group I Vs 52 in group II which represents the study population. Neoadjuvant concurrent treatment was given in the form of 2 cycles of chemotherapy consisted of 5 Fu (325 mg/m2) & Mitomycin (6 mg /m2) & 50 Gy of radiation therapy (1.8 to 2 Gy /day x 5 days). Surgery was performed about 6-8 weeks after neoadjuvant treatment. Preclinical staging was performed by a combination of history, physical examination, imaging by contrast enhanced CT scan of abdomen/pelvis. TNM classification (UICC) was used to classify tumors. Data were collected retrospectively for age, gender, pretreatment staging, duration of surgery, intraoperative blood loss, conversion to open surgery & postoperative data including morbidity, mortality & histopathology report. Exclusion criteria for laparoscopic surgery were significant comorbid illnesses (i.e. diabetes, hypertension & ischemic heart disease), history of previous pelvic surgery, & adherence to other structures on imaging. CONCLUSION : Present study suggests that laparoscopic surgery for rectal cancer can be performed after neoadjuvant chemoradiation with equal morbidity and oncological safety with significantly less blood loss. This needs confirmation by prospective randomized trials.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Rectal Cancer ; Neoadjuvant ; Chemoradiation ; Open ; Laparoscopic Surgery.
Subjects: MEDICAL > Surgical Oncology
Depositing User: Kambaraman B
Date Deposited: 26 Jul 2017 02:39
Last Modified: 26 Jul 2017 02:39
URI: http://repository-tnmgrmu.ac.in/id/eprint/2127

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