RESUMEN
BACKGROUND: The minilaparotomy approach is technically feasible for the resection of rectal cancer in selected patients with rapid postoperative recovery and small incision. The study aimed to compare the clinical and oncological outcomes of minilaparotomy and laparoscopic approaches in patients with rectal cancer. METHODS: The 122 included patients with rectal cancer were assigned to either minilaparotomy group (n=65) or laparoscopic group (n=57) which ran from January 2005 to January 2008. Clinical characteristics, perioperative outcomes, postoperative and long-term complications, pathological results and survival rates were compared between the groups. RESULTS: The demographic data of the two groups were similar. The time to normal diet (P=0.024) and the hospital stay (P=0.043) were less in the laparoscopic group than that in the minilaparotomy group. Compared with the minilaparotomy group, the mean operation time was significantly longer [low anterior resection (LAR), P=0.030; abdominoperineal resection (APR), P=0.048] and the direct costs higher for laparoscopic group (P<0.001). The morbidity and mortality were comparable between the two groups. Local recurrence was similar (5.3% laparoscopic, 1.5% minilaparotomy, P=0.520). The 5-year overall and disease-free survival rates were also similar (overall survival is 87.1% in laparoscopic group, and 82.5%in minilaparotomy group, P=0.425; disease-free survival is 74.2% in the laparoscopic group, and 71.4% in mini- laparotomy group, P=0.633). CONCLUSIONS: The minilaparotomy approach was similarly safe and oncologically equivalent to laparoscopic approach for patients with rectal cancer. At the expense of a longer operative time and higher cost, laparoscopic surgery was associated with faster postoperative recovery.
RESUMEN
La obesidad ha sido considerada la epidemia mundial del siglo XXI; hasta el momento no existe un manejo médico y/o farmacológico que permita controlar o disminuir significativamente las comorbilidades asociadas a esta enfermedad. La cirugía bariátrica se ha posesionado como la mejor alternativa para el manejo de estos pacientes y requiere para su realización centros de referencia con grupos multidisciplinarios comprometidos con la escogencia y seguimiento a largo plazo para estos pacientes. El bypass gástrico continúa siendo el patrón de oro para el manejo quirúrgico de la obesidad mórbida.
Obesity is considered to be the epidemic of the 21st century. Until now there are no known medical or pharmacological methods to manage obesity in ways that control it and significantly reduce the comorbidities associated with it. Bariatric surgery has become the best alternative for management of obesity. Management of patients undergoing bariatric surgery requires referral centers with multidisciplinary medical groups committed to choice and long term follow-up of these patients. Bariatric surgery continues to be the gold standard for surgical management of morbid obesity.