Laparoscopic Surgery Oncological Surgery Treatment and Results

 

Lap Trainer Box

Lap Trainer Box

Rules Oncological Surgery

Regarding the rules of oncological surgery, it remembered on the one hand the need for sufficient supra and sub-tumoral safety margins, and on the other hand the obligation of vascular ligatures at their origin in order to obtain a large lymphadenectomy. . This was the case in our series since the number of lymph nodes removed, namely 13 and 14 respectively for the right ileo-colic and recto-sigmoid resections, met the required criteria. In this regard, certain prospective series had shown that the main oncological principles observed in laparoscopy, data corroborated by 3 randomized studies.

For a large number of reasons use of simulators is a prudent choice like Lap Trainer Box.

Treatment

However, what about the 5-year survival results? It varies after curative resection, from 64% to 73%. However, these figures are similar to those for surgery by laparotomy. Only multicenter studies, currently underway in several countries and comprising a large number of patients and statistically exploitable, will make it possible to make a definitive judgment as to the merits of laparoscopy in the treatment of colorectal cancer. We identified some findings in a single-center randomized study including 219 patients (111 for laparoscopy and 118 for laparotomy). It concluded that there was no significant difference in overall survival at 5 years and that there was an advantage in this survival for advanced stage III cancers.

Trocar Openings

Regarding metastases on the trocar openings, an abnormally high rate observed in the first series of laparoscopic colectomies, hence cautionary advice as to the surgical indications for cancer. This was particularly the case in our initial experience as evidenced by our high rate of conversions, which decided when the tumor had crossed the colonic serosa. An assessment difficult to assess during the preoperative staging of the tumor by imaging alone (ultrasound and scanner). However, some series reported much lower numbers of metastases on trocar openings, in the order of 0% to 2.5%, which has confirmed by a recent cumulative study covering 3,942 cases and reporting a rate of 0.3%.

This percentage superimposed if not lower.  To that of parietal metastases observed after laparotomies and varies from 0.9% to 1.5%. In our series, the rate of metastases on a trocar opening is 0.7% (1/141 cases) and we only observed it at the start of our practice. A large number of experimental works have been done on this subject and this is how it has been mentioned as pathogenic hypotheses: the "chimney" effect (the cancer cells circulating within the pneumoperitoneum being liable to attach themselves to It. raw tissue from the openings of the trocars), the deleterious action of CO, the level.

Results

Pressure of the pneumoperitoneum but above all the direct implantation of cancer cells by the instruments of the surgeon handling the tumor. Preventive measures have proposed, in particular the absence of manipulation of the tumor by instrumentation, the protection of the extraction site by a plastic device, and the closing of the peritoneum of the trocar openings after application. Of a cytolytic product. Ultimately, the determining factor seems to be the lack of surgical experience results in untimely manipulation of the tumor and the lymph nodes.

It has argued that laparoscopy would have the advantage of causing less postoperative immune depression than “open” surgery. A fact that would give interest, at least theoretically, to laparoscopy in the treatment of cancer. In this regard, many studies have carried out, some on the immune response of the acute inflammatory phase, others on humoral and cellular immunity. However, none of them has been able to assert a real advantage in this area in favor of laparoscopy.

Conclusion

Can we operate with laparoscopy colorectal cancer? The answer is in the affirmative, but requires that the operator has an excellent command of colorectal surgery, both laparotomy and laparoscopy, that he is able to scrupulously respect the rules of oncological surgery and provided he does not operate only on tumors that are small (less than 3-4 cm) or do not completely penetrate the walls of the intestine.

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