Electro-thermal bipolar vessel sealing versus clipping of the inferior mesenteric vessels during minimally invasive proctectomy.

INTRODUCTION: The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. METHODS: This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). RESULTS: The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. CONCLUSION: Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.

ANTECEDENTES: La introducción de nuevos dispositivos de sellado de vasos energéticos en la proctectomía mínimamente invasiva condujo a un mejor efecto hemostático, una menor pérdida de sangre y un tiempo de operación más corto. Actualmente, la evidencia disponible en la literatura sobre el uso de EBVS (electro-thermal bipolar vessel sealers) en cirugía laparoscópica de cáncer rectal es débil, pues la mayoría de los estudios son retrospectivos con grupos de pacientes no homogéneos. MÉTODO: Estudio de cohorte retrospectivo con 40 pacientes con cáncer rectal operados por escisión mesorrectal total laparoscópica o asistida por laparoscopia, clasificados en dos grupos según el enfoque de la ligadura de los vasos mesentéricos inferiores (EBVS vs. recorte). RESULTADOS: El tiempo operatorio fue significativamente mayor y la pérdida de sangre fue significativamente mayor en el grupo EBVS. Sin embargo, el método de control vascular no afectó significativamente el tiempo de hospitalización, el tiempo hasta el inicio de la función del estoma ni el número de ganglios linfáticos recuperados. CONCLUSIÓN: Ambos métodos para el control del pedículo vascular durante la cirugía de cáncer rectal mínimamente invasiva son seguros, por lo que queda a discreción del cirujano el método a utilizar. Se esperan ensayos prospectivos bien diseñados para proporcionar pruebas más sólidas.

Clinico-epidemiologic criteria and predictors of survival of rectal cancer among Egyptians in Delta region / Critérios clínico-epidemiológicos e preditores de sobrevida do câncer retalentre egípcios na região do Delta

Abstract Background Colorectal cancer represents a global health problem. Rectal cancer in particular is increasing and is believed to carry a unique epidemiologic and prognostic criteria. Method We herein study retrospectively the data of 245 patients from a tertiary center in Egypt. Clinico-epidemiologic criteria and predictors of survival are analyzed. Results The disease affects younger population without sex predilection. Prognosis is affected by age, nodal status, metastasis, and bowel obstruction. Conclusion Rectal cancer has unique criteria in the Egyptian population. A national population based registry is recommended to delineate the nature of the disease in Egypt.

Resumo Introdução O câncer colorretal é um problema de saúde global. A incidência de câncer retal, em particular, está aumentando; acredita-se que esta neoplasia apresente critérios epidemiológicos e prognósticos únicos. Métodos O presente estudo avaliou retrospectivamente os dados de 245 pacientes de um centro terciário no Egito. Critérios clínico-epidemiológicos e preditores de sobrevida foram analisados. Resultados A doença afeta a população mais jovem, sem predileção por sexo. O prognóstico é afetado pela idade, estado nodal, metástase e obstrução intestinal. Conclusão O câncer retal apresenta critérios únicos na população egípcia. Recomenda-se um registro nacional de base populacional para delinear a natureza da doença no Egito.