Hand-Assisted Laparoscopic Rectal Resection-Experience of a Tertiary Oncology Center

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Colorectal Surgery

Background:

• Hand-assisted laparoscopic surgery (HALS) is a potential technique for rectal anterior resection (RAR).
• Limited evidence currently supports the efficacy and safety of HALS for RAR.
• This study evaluates HALS for RAR outcomes at a specialized cancer center.

Purpose of the Study:

• To assess the perioperative outcomes of HALS for RAR.
• To evaluate the oncological results of HALS for RAR.
• To determine the safety and feasibility of HALS for RAR in a tertiary oncology setting.

Main Methods:

• Retrospective observational study of 469 patients undergoing HALS for RAR (2013-2022).
• Inclusion criteria: primary adenocarcinoma of the rectosigmoid junction and rectum.
• Data collected on operative time, conversion rates, morbidity, mortality, anastomotic leaks, and oncological outcomes.

Main Results:

• Median operative time was 152 minutes with a 3.8% conversion rate.
• Major morbidity was 10.0%, with 30-day mortality at 0.9% and 90-day mortality at 1.3%.
• Achieved complete mesorectal excision (89.6%), R0 resection (96.2%), 5-year overall survival (82.6%), with low recurrence rates (locoregional 2.5%, distant 5.9%).

Conclusions:

• HALS for RAR is a safe and feasible surgical option when performed by experienced colorectal teams.
• The technique is associated with favorable perioperative metrics, including short operative times and low conversion rates.
• HALS for RAR demonstrates optimal oncological performance with minimal morbidity and good long-term survival.