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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2013, Number 4

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An Med Asoc Med Hosp ABC 2013; 58 (4)

Total mesorectal excision: Is it laparoscopic approach the new gold standard?

Molina-López JF, Belmonte MC

Language: Spanish
References: 38
Page: 260-266
PDF size: 247.44 Kb.


ABSTRACT

Introduction: We present a state of the art of laparoscopy versus conventional approach in the management of rectal cancer. Materials and methods: Electronic searches (Pubmed, Cochrane libray and MD Consult) until May of 2013 were performed. Meta-analysis and systematic reviews in the last six years are included. Results: Three of latest meta-analysis and an extensive review by Cochrane were analyzed. Laparoscopic surgery showed superiority over the open approach when calculated by intraoperative bleeding, fewer number of blood units transfused, earlier time to resume oral intake and shorter hospital stay. No difference was found in morbidity, mortality and oncological outcomes such as: local recurrence rate, number of lymph nodes harvested or resection margins when compared both groups. The longest survival traces are few clinical trials with small numbers of patients or non-randomized prospective studies with inconsistent data. Conclusion: Total mesorectal excision by laparoscopy has shown better perioperative results and with oncologic outcome at least comparable with open surgery. There is not yet enough evidence to evaluate long-term survival.


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