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Standardised approach to laparoscopic total mesorectal excision for rectal cancer: a prospective multi-centre analysis

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Abstract

Purpose

Two non-inferiority randomised control trials have questioned the utility of laparoscopic surgery for rectal cancer by failing to prove that pathological markers of high-quality surgery are equivalent to those achieved by open technique. We present short- and long-term post-operative outcomes from the largest single surgeon series of consecutive patients undergoing laparoscopic TME for rectal cancer. We describe the standardised laparoscopic technique developed by the principal surgeon, and the short-term outcomes from three surgeons who were trained in and subsequently adopted the same approach.

Methods

Prospectively acquired data from consecutive patients undergoing surgery for rectal cancer by the principal surgeon at the minimally invasive colorectal unit in Portsmouth between 2006 and 2014 were analysed along with data acquired between 2010 and 2017 from surgeons at three further international centres. Endpoints were overall and disease-free survival at 5 years, and early post-operative clinical and pathological outcomes.

Results

Two hundred sixty-three consecutive patients underwent laparoscopic TME surgery by the principal surgeon. At 5 years, overall survival was 82.9% (Dukes’ A = 94.4%; B = 81.6%; C = 73.7%); disease-free survival was 84.0% (Dukes’ A = 93.3%; B = 86.8%; C = 72.6%). Post-operative length of stay, lymph node harvest, mean operating time, rate of conversion, major morbidity and 30-day mortality were not significantly different between the principal surgeon and those he had trained when subsequently in independent practices.

Conclusion

Laparoscopic TME produces excellent long-term survival outcomes for patients with rectal cancer. A standardised approach has the potential to improve outcomes by setting benchmarks for surgical quality, and providing a step-by-step method for surgical training.

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Author information

Authors and Affiliations

  1. Department of Academic Surgery, University Hospital Southampton, Southampton, UK

    Marc Bullock

  2. Laparoscopic and Robotic Colorectal Unit, Fundação Champalimaud, Lisbon, Portugal

    Irfan Ul Islam Nasir, Nuno Figueiredo, Richard Heald & Amjad Parvaiz

  3. Department of Colorectal Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK

    Anil Hemandas

  4. Department of Minimal Invasive Colorectal Surgery, Poole Hospital NHS Foundation Trust, Long fleet Road, Poole, Dorset, BH15 2JB, UK

    Tahseen Qureshi & Amjad Parvaiz

  5. Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK

    Amjad Parvaiz

Authors
  1. Marc Bullock
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  2. Irfan Ul Islam Nasir
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  3. Anil Hemandas
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  4. Tahseen Qureshi
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  5. Nuno Figueiredo
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  6. Richard Heald
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  7. Amjad Parvaiz
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Contributions

Acquisition of data by Marc Bullock, Anil Hemandas, Tahseen Qureshi, Nuno Figueiredo and Amjad Parvaiz; analysis and interpretation of data was done by Marc Bullock, Irfan Ul Islam Nasir, Anil Hemandas, Tahseen Qureshi, Nuno Figueiredo and Amjad Parvaiz; drafting of manuscript was done by Marc Bullock, Irfan Ul Islam Nasir, Anil Hemandas, Tahseen Qureshi, Nuno Figueiredo, Richard Heald and Amjad Parvaiz; critical revision of manuscript was done by Marc Bullock, Irfan Ul Islam Nasir, Richard Heald and Amjad Parvaiz.

Corresponding author

Correspondence to Amjad Parvaiz.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bullock, M., Nasir, I.U.I., Hemandas, A. et al. Standardised approach to laparoscopic total mesorectal excision for rectal cancer: a prospective multi-centre analysis. Langenbecks Arch Surg 404, 547–555 (2019). https://doi.org/10.1007/s00423-019-01806-w

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  • DOI: https://doi.org/10.1007/s00423-019-01806-w

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