1. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER PAST – PRESENT – FUTURE
Phạm Văn Bình MD, PhD
National Cancer Hospital – Viet Nam ( K Hospital )

5. BACKGROUND Incidence and Mortality
WHO 2012 : new cases, deaths of colorectal cancer worldwide (10% of all cancer )
AMERICAN 2013 ( ASCRS ): new cases of colon cancer, new cases of rectal cancer, colorectal cancer deaths.
EUROPE: incedence rate of 50/ , colorectal cancer deaths
VIỆT NAM ( ): incedence rate of 13,7- 17,1/

6. COLORECTAL CANCER - GLOBOCAN 2012
Incidence
Mortality

7. MULTIDISCIPLINARY RADIOTHERAPY – SURGERY – CHEMOTHERAPY

8. SURGERY FOR COLORECTAL CANCER
Laparoscopy
Laparotomy

9. HISTORY OF LAPAROSCOPIC SURGERY
CELIOSCOPIE
CELIO : Ổ BỤNG
SCOPIE : SOI , QUAN SÁT
LAPAROSCOPY
LAPA: Ổ BỤNG SCOPY : SOI , NHÌN VÀO TRONG

10. HISTORY OF LAPAROSCOPIC SURGERY
HYPPOCRATES: V century B.C: rectal examination, transanal air enema for treatment.
The first idea of minimally Invasive Approaches

11. Aranzi, the first person use solar lighting for nasal endoscopy
Giulio Cesare Aranzi ( 1530–1589)
TROCART – England

12. HISTORY OF LAPAROSCOPIC SURGERY
Antoine jean desormeaux

13. HISTORY OF LAPAROSCOPIC SURGERY
Thomas alva edison
Incandescent light bulb was invented 10/1879

14. Georg KELLING 1866-1945: FIRST EXPERIENTIAL LAPAROSCOPIC SURGERY WITH INSUFFLATION OF GAS 1901

15. HISTORY OF LAPAROSCOPIC SURGERY
Harold Horace Hopkins (1918–1994): Invented Rigid rod lens system 1953 creating a revolution in image transmission in laparoscopic surgery

16. HISTORY OF LAPAROSCOPIC SURGERY
A robotic arm is designed and tested in Silicon Valley. Robot Da Vinci is used in laparoscopic surgery in developed countries

17. HISTORY OF LAPAROSCOPIC SURGERY
Erich Muhe 1985
Philippe Mouret 1987

18. Lindbergh Operation First transatlantic robot-assisted operation 2003
Strasbourg
New York

19. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
Possibility of radical resection?
Possibility of radical lymph node dissection?
Laparoscopic surgery spreads cancer cells?
Recurrence rate, survival in comparison with laparotomy surgery?

20. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
RJ Heald Deputy chairman of the Association of Royal British Surgeons: Total Mesorectal Excision – TME
The most important change in more than 100 years: locoregional recurrence decrease from 15-40% to 4%.
Laparoscopic surgery: TME is standard for low and middle rectal cancer.
PR HEALD

21. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
The first laparoscopic surgery for colon cancer was performed in in US: first report of 20 cases operated with right hemicolectomy in American Academy Institute
Pr JACOBS

22. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
JM. SACKIER (USA) 1992
Laproscopic Abdominoperineal Resection for 63 year old female patient
Published in Lancet Journal in 1993 7

23. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
Aziz .0 ( ): Medline, Embase, Ovid, Cochrane
Objective: controlled, multicenter comparison between laparoscopic surgery and open surgery on outcome in term of surgery and oncology?
Results: 22 studies with 2071 patients.
The 10 years overall outcome in application of laparoscopic surgery focused on technique: Oncology outcome is not significant.
Aziz O., Constantinides V., Tekkis P. et al (2006), "Laparoscopic versus open surgery for rectal cancer: a meta-analysis", Ann Surg Oncol, (13), pp 23

24. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
CLASSIC Tria:l Royal Medical Council (UK) (2007):
Objective: controlled, multicenter, prospective comparison between laparoscopic surgery and open surgery
Results: 27 surgery centers with 794 patients
Conclusions: Surgical and Oncology outcome (The number of harvested lymph nodes , CMR, Recurrence rate, Metastasis rate) are equivalent
Guillou P., Quirke P., ThorpeH. et al (2005), "Short - term endpoints of conventional versus laparoscopic - assisted surgery in patients with colorectal cancer (MRC CLASICC Trail): multicenter randomized controlled trial",The lancet, (365), pp
WILEY ( ) : 33NC lâm sàng 3346 BN/ 46 tạp chí

25. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
Lourenco - SURG ENDO (2008 ):
Objective: To compare the results of laparoscopic surgery and open surgery for colorectal cancer from
Results: 4500 patients in 18 centers. The number of harvested lymph nodes, survival, recurrence, metastasis rate are equivalent, trocart implant rate <1%
Lourenco T., Murray A., Grant A. et al (2008), "Laparoscopic surgery for colorectal cancer: safe and effective? A systematic review",Surg Endosc, (22), pp

26. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
Pulishing House WILEY ( 2008) :
Objective: controlled, multicenter comparison between laparoscopic surgery and open surgery
Results: From 1998 to 2007: 3346 patients of 33 studies on 46 journals
The number of harvested lymph nodes, survival, recurrence, metastasis rate are equivalent
Kuhry E., Schwenk W., Gaupset R. (2008), "Long - term results of laparoscopic colorectal cancer resection", The Cochrane collaboration Published by Wiley & Sons, pp

27. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
COLOR – EURO (2005)
COST- US ( 2004)
CLASSIC – UK (2007)
Surgery outcome:
Operation time: longer than minutes
Blood loss during surgery: less
Conversion to open surgery: 0% - 15%
Complications: anastomotic leakage of 2% -5%, mortality of 0.5% -1.5%
Length of hospital stay: shorter.
Nervous urinary genital complications: less
Higher costs

28. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER ONGOING STUDIES
JAPAN: The Japan Clinical Oncology Group Study : 10 year outcome
EURO : The European Colorectal Cancer Laparoscopic or Open Resection II trial: controlled, multicenter comparison: 5 year survival
USA : The American College of Surgeon Oncology Group III triall / 650 patient, Hypothesis: laparoscopic surgery is not inferior to open phase in colorectal cancer stage II-III. 24

29. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER
FACTORS AFFECTING RESULTS
Disease stage?
Adjuvant treatment?
The expertise of surgeons?
Lymph node dissection? (Independent prognostic factors)
Ostadi M. A., Harnish J. L., Stegienko S. et al (2007), "Factors affecting the number of lymph nodes retrieved in colorectal cancer specimens", Surg Endosc, (21), pp

30. LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER: FUTURE
LAPAROSCOPIC SURGERY SINGLE PORT
NOTE : Natural Orifice Translumenal Endoscopic Surgery
ROBOTIC LAPAROSCOPY

31. 2008 Dr Dan Geisler Single port colectomy Chicago

32. 2008 Dr Dan Geisler Single port colectomy Chicago - USA

33. NOTES : Natural Orifice Translumenal Endoscopic Surgery 2008

34. ROBOCTIC LAPAROSCOPY 2000 Robot Da Vinci : Ohio – Cardiothoracic surgery
Leonardo Da Vinci
Mona Lisa

35. ROBOCTIC LAPAROSCOPY
HISTORY OF ROBOT: 1921 Karel Capek Czech playwright used the term “robot” in the play 'Rossom`s Universal Robots' to describe a tirelessly working machine performing from repetitively simple movements to intelligent movements such as human.

36. ROBOCTIC LAPAROSCOPY

37. ROBOTIC COLORECTAL SURGERY
PubMed and Google Scholar :
Objective: To evaluate the results of robot surgery
Results: 69 studies show less blood loss, faster recovery, less conversion to open surgery, and longer operative time
Conclusions: In term of surgery, robotic surgery is superior, regarding to oncology, it is equivalent to traditional surgery.
KIM.CW ( )“Outcomes of Robotic-Assisted Colorectal Surgery Compared with Laparoscopic and Open Surgery: a Systematic Review” Journal of Gastrointestinal Surgery , Source: PubMed

38. ROBOTIC COLORECTAL SURGERY
Pubmed, Web of Science, and Cochrane Library
Objective: To compare robotic surgery with laparoscopic surgery
Results: 110 patients with robotic surgery and 116 patients with laparoscopic surgery. Robotic arm has longer operative time, less blood loss, less conversion to open surgery, fewer complications, faster recovery, the same number of dissected nodes and clear margin.
Conclusion: Oncology research is needed Regulators
LIAOG.C (4/2014) “Robotic-assisted versus laparoscopic colorectal surgery: a meta-analysis of four randomized controlled trials”. World Journal of Surgical Oncology
Robotic colorectal surgery is a promising tool

39. ROBOTIC COLORECTAL SURGERY
Robot-Assisted Versus Conventional Laparoscopic Surgery for Colorectal Disease, Focusing on Rectal Cancer: A Meta-analysis Ann Surg Oncol Nov
Objective: To compare robotic surgery with laparoscopic surgery for rectal cancer
Results: 17 studies – robotic surgery has less blood loss during surgery and less conversion rate, and the same complication and cancer outcome in comparison with conventional laparoscopic surgery.
Conclusion RACLS: Promising tool

40. ROBOTIC COLORECTAL SURGERY
Robotic Surgery for Rectal Cancer: An Update in 2016 Cancer Res Treat. 2016;48(2):
Jung Myun Kwak, MD, PhD Seon Hahn Kim, MD, PhD
Objective : ROBOT- LAPAROSCOPY
Conclusion : more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery.

41. CONCLUSION
LAPAROSCOPY
LAPAROTOMY

42. CONCLUSION Laparoscopic Surgery: superior in surgery outcome
Laparoscopic Surgery: equivalent to open surgery in cancer outcome.
Da Vinci robotic laparoscopic surgery: being studied
Laparotomy : traditional surgery

43. THANH YOU FOR YOUR ATTENTION66