Laparoscopic rectal surgery for middle and lower rectal cancer

The usefulness of laparoscopic low anterior resection for middle and lower rectal cancer remains controversial.

Retrospective assessment was performed on 98 patients (51 with middle and 47 with lower rectal cancer) who underwent laparoscopic rectal surgery since 1998. Total mesorectal excision was standard. Cancers were classified as middle or lower rectal based on distance from the distal tumor border to the anal verge (<8 cm or ≥8 cm). Laparoscopic rectal surgery was performed with five or six ports and carbon dioxide pneumoperitoneum. Rectal mobilization was usually done by electrocautery and vessels were sealed with a LigaSureV. Pelvic anatomy was accurately visualized by endoscopic magnification, so autonomic nerves could be preserved. The rectum was mobilized just above the levator muscles. Operative variables and the short- and long-term outcomes were investigated.

Five open conversions were required, including three early cases related to rectal transection problems. The other two were for a large tumor and adhesions. Mean operating time was 236 min and blood loss was 147 g. Postoperative complications were 13 cases of anastomotic leakage (13.1%), 6 wound infections (6.1%), 4 cases of anastomotic bleeding (4.0%), and 3 cases of urinary retention (3.0%). Total morbidity was 32.2%, but there were no fatal complications or operative deaths. Mean postoperative period until bowel movement, oral intake, and hospital discharge was 1.6, 1.3, and 19.7 days, respectively. Twelve patients had recurrence: local in 3, lymph node in 2, lung in 5, and liver in 2. The 5-year disease-free/overall survival rates were 82.3/95.7% in stage I, 55.1/72.0% in stage II, and 59.5/80.7% in stage III.

Laparoscopic low anterior resection achieves acceptable short- and long-term outcomes. It is a useful option even for advanced lower rectal cancer.