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Surgical Endoscopy

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01-02-2011

Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients

Authors: C. A. Sartori, A. Dal Pozzo, B. Franzato, M. Balduino, A. Sartori, G. L. Baiocchi

Published in: Surgical Endoscopy | Issue 2/2011

Abstract

Background

Laparoscopic total mesorectal excision for low rectal cancer is not considered a gold standard treatment due to the high conversion rate and the long operation time.

Methods

A retrospective review examined a surgical series of 174 laparoscopic low rectal resections involving total mesorectal excision (1995–2006), with particular reference to technical points as well as surgical and oncologic outcomes. Miles operations and partial mesorectal excisions were excluded.

Results

The cancer affected the low rectum in 110 cases and the medium rectum in 64 cases. A total of 68 patients were subjected to neoadjuvant radiochemotherapy. The anastomosis was mechanical for 83.3% of the cases and intersphinteric through the perineum for 16.6% of the cases. Protective ileostomy was performed in 112 cases. The conversion rate was 4.6%. The mesorectum remained intact in 91.6% of the cases and was partially interrupted in 15 of the cases. In no case was it totally discontinued. The postoperative morbidity rate was 16.7%, and the mortality rate was 0.57%. The incidence of anastomotic fistulas was 14.4%. The percentage was higher for males (18.6 vs 8.3%) and correlated with the low distance of the tumor from the anal verge (18.2 vs 7.8%) and the absence of a protection ileostomy (20.9 vs 10.7%). After an average follow-up period of 48.6 months (range, 24–149 months), six patients (3.44%) experienced a pelvic recurrence. The 5-year overall survival rate was 75.4%, and the disease-free survival rate was 61.9%.

Conclusion

Laparoscopic total mesorectal excision for low rectal cancer is safe and effective, allowing surgical and oncologic outcomes similar to those reported for open surgery.

Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 16(2):CD003432

Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44:315–321CrossRefPubMed

Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342CrossRefPubMed

Bärlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19:757–766CrossRefPubMed

Law WL, Lee YM, Choi HK, Seto CL, Ho JW (2006) Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 49:1108–1115CrossRefPubMed

Heald RJ, Husband EM, Ryall RDH (1969) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 1969:613–616

Murty M, Enker WE, Martz J (2000) Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer. Semin Surg Oncol 19:321–328CrossRefPubMed

Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer: long-term outcomes. Surg Endosc 18:281–289CrossRefPubMed

Dulucq JL, Wintringer P, Stabilini C, Mahajna A (2005) Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 19:1468–1474CrossRefPubMed

10.

Weiser MR, Milsom JW (2000) Laparoscopic total mesorectal excision with autonomic nerve preservation. Semin Surg Oncol 19:396–403CrossRefPubMed

11.

Pugliese R, Di Lernia S, Sansonna F, Scandroglio I, Maggioni D, Ferrari GC, Costanzi A, Magistro C, De Carli S (2008) Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases. Am J Surg 195:233–238CrossRefPubMed

12.

Selvindos PB, Ho YH (2008) Multimedia article: laparoscopic ultralow anterior resection with colonic J-pouch-anal anastomosis. Dis Colon Rectum 51:1710–1711 Epub 5 August 2008CrossRefPubMed

13.

Tsang WW, Chung CC, Kwok SY, Li MK (2006) Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 243:353–358CrossRefPubMed

14.

Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451CrossRefPubMed

15.

Chung CC, Ha JP, Tsang WW, Li MK (2001) Laparoscopic-assisted total mesorectal excision and colonic J-pouch reconstruction in the treatment of rectal cancer. Surg Endosc 15:1098–1101CrossRefPubMed

16.

Zhou ZG, Wang Z, Yu YY, Shu Y, Cheng Z, Li L, Lei WZ, Wang TC (2003) Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter: a report of 82 cases. World J Gastroenterol 9:1477–1481PubMed

17.

Law WL, Chu KW, Tung HM (2004) Early outcomes of 100 patients with laparoscopic resection for rectal neoplasm. Surg Endosc 18:1592–1596PubMed

18.

Staudacher C, Vignali A, Saverio DP, Elena O, Andrea T (2007) Laparoscopic vs open total mesorectal excision in unselected patients with rectal cancer: impact on early outcome. Dis Colon Rectum 50:1324–1331CrossRefPubMed

19.

Yang L, Yu YY, Zhou ZG, Li Y, Xu B, Song JM, Liu HY, Jiang X (2007) Quality-of-life outcomes following laparoscopic total mesorectal excision for low rectal cancers: a clinical control study. Eur J Surg Oncol 33:575–579CrossRefPubMed

20.

Zhou ZG, Hu M, Li Y, Lei WZ, Yu YY, Cheng Z, Li L, Shu Y, Wang TC (2004) Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18:1211–1215CrossRefPubMed

21.

Ding KF, Chen R, Zhang JL, Li J, Xu YQ, Lv L, Wang XC, Sun LF, Wang JW, Zheng S, Zhang SZ (2008) Laparoscopic surgery for the curative treatment of rectal cancer: results of a Chinese three-center case-control study. Surg Endosc 23:854–861CrossRefPubMed

22.

Quah HM, Jayne DG, Eu KW, Seow-Choen F (2002) Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer. Br J Surg 89:1551–1556CrossRefPubMed

23.

Bianchi PP, Rosati R, Bona S, Rottoli M, Elmore U, Ceriani C, Malesci A, Montorsi M (2007) Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes. Dis Colon Rectum 50:2047–2053CrossRefPubMed

24.

Delgado S, Momblán D, Salvador L, Bravo R, Castells A, Ibarzabal A, Piqué JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients; lesson learned from >200 patients. Surg Endosc 18:1457–1462CrossRefPubMed

25.

Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16:848–857CrossRefPubMed

26.

Simunovic M, Sexton R, Rempel E, Moran BJ, Heald RJ (2003) Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Br J Surg 90:999–1003CrossRefPubMed

27.

Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268CrossRefPubMed

28.

Carlsen E, Schlichting E, Guldvog I, Johnson E, Heald RJ (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529CrossRefPubMed

29.

Havenga K, Enker WE, Norstein J, Moriya Y, Heald RJ, van Houwelingen HC, van de Velde CJ (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1, 411 patients. Eur J Surg Oncol 25:368–374CrossRefPubMed

30.

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision 1978–1997. Arch Surg 133:894–899CrossRefPubMed

31.

Feliciotti F, Guerrieri M, Paganini AM, De Sanctis A, Campagnacci R, Perretta S, D’Ambrosio G, Lezoche E (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17:1530–1535CrossRefPubMed

32.

Morino M, Giraudo G (2005) Laparoscopic total mesorectal excision: the Turin experience. Recent Results Cancer Res 165:167–179CrossRefPubMed

Title: Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients
Authors: C. A. Sartori
A. Dal Pozzo
B. Franzato
M. Balduino
A. Sartori
G. L. Baiocchi
Publication date: 01-02-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1202-z

At a glance: The STEP trials

Springer Medicine

Laparoscopic total mesorectal excision for rectal cancer: experience of a single center with a series of 174 patients

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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