World Journal of Surgery

, Volume 37, Issue 4, pp 883–892 | Cite as

Laparoscopic Surgery for Rectal Cancer: Outcomes in 513 Patients

  • Oktar Asoglu
  • Emre BalikEmail author
  • Enver Kunduz
  • Sumer Yamaner
  • Ali Akyuz
  • Mine Gulluoglu
  • Yersu Kapran
  • Dursun Bugra



Few reports have demonstrated the feasibility and efficacy of laparoscopic resection in patients with rectal cancer (RC). The objective of the present study was to assess the effectiveness of laparoscopic resection for RC, with an emphasis on perioperative variables and long-term oncological outcomes.


This prospective study was carried out between January 2005 and September 2010 and included 513 patients diagnosed with RC who underwent laparoscopic surgery. Patients with locally advanced RC (cT3/cT4 or N+) received neoadjuvant treatment. Adjuvant treatment was applied to patients with stage II/III disease or according to the neoadjuvant protocol. All patients were followed-up prospectively for the evaluation of complications and oncological outcome. Survival rate analysis was performed using the Kaplan–Meier method.


Sphincter-preserving surgery was performed on 389 patients, and the remaining 124 patients underwent abdominoperineal resection. Perioperative mortality occurred in only one patient (0.2 %), and 27 (5.3 %) intraoperative complications were recorded. The most common postoperative complication was anastomotic leakage (5.5 %). The conversion rate was 6.4 %. The mean number of harvested lymph nodes was 23.6 ± 13. The mean distance to the distal margin was 2.6 ± 1.9 (0–7) cm. Distal margin positivity was detected in 9 (1.7 %) patients. The circumferential margin was positive in 39 (7.6 %) cases. After a median follow-up period of 30 (1–78) months, recurrence occurred in a total of 59 patients (11.5 %). Local recurrence was detected in 16 patients (3.1 %), and both local and distant recurrence was found in 7 patients (1.4 %). Distant recurrence only was detected in 43 patients (8.4 %). The overall 5-year survival rate was 84 %, and the 5-year disease-free survival rate was 77.4 %. The local recurrence-free survival rate was 98.4 % at 2 years, 95.7 % at 3 years, and 94.3 % at 5 years.


Our results, together with the review of the literature, clearly demonstrate that laparoscopic resection for RC is a feasible method at specialized high-volume centers. The long-term outcomes are at least as good as those from open surgery as long as the principles of oncologic surgery are respected and faithfully performed.


Rectal Cancer Total Mesorectal Excision Laparoscopic Resection Laparoscopic Anterior Resection Complete Total Mesorectal Excision 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to the following members of the Faculty of Medicine, Istanbul University: Baris Bakir (Radiology) for radiologic diagnostic support; Turker Bulut (General Surgery) and Yilmaz Buyukuncu (General Surgery) for surgical team support; Hasan Karanlik (Oncology) for the statistical work-up; and Esra Saglam (Oncology) and Sezer Saglam (Oncology) for oncological therapeutic support for this study.


  1. 1.
    Aziz O, Constantinides V, Tekkis PP et al (2006) Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 13:413–424PubMedCrossRefGoogle Scholar
  2. 2.
    Gao F, Cao YF, Chen LS (2006) Meta-analysis of short-term outcomes after laparoscopic resection for rectal cancer. Int J Colorectal Dis 21:652–656PubMedCrossRefGoogle Scholar
  3. 3.
    Asoglu O, Matlim T, Karanlik H et al (2009) Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer. Surg Endosc 23:296–303PubMedCrossRefGoogle Scholar
  4. 4.
    Balik E, Asoglu O, Saglam S et al (2010) Effects of surgical laparoscopic experience on the short-term postoperative outcome of rectal cancer: results of a high volume single center institution. Surg Laparosc Endosc Percutan Tech 20:93–99PubMedCrossRefGoogle Scholar
  5. 5.
    Vignali A, Fazio VW, Lavery IC et al (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113PubMedGoogle Scholar
  6. 6.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  7. 7.
    Hermanek P, Hermanek P, Hohenberger W et al (2003) The pathological assessment of mesorectal excision: implications for further treatment and quality management. Int J Colorectal Dis 18:335–341PubMedGoogle Scholar
  8. 8.
    Feliciotti F, Guerrieri M, Paganini AM et al (2003) Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients. Surg Endosc 17:1530–1535PubMedCrossRefGoogle Scholar
  9. 9.
    Ng SS, Leung KL, Lee JF et al (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425; Erratum. Ann Surg Oncol 2009 16:229Google Scholar
  10. 10.
    Ng SS, Leung KL, Lee JF et al (2009) Long-term morbidity and oncologic outcomes of laparoscopic-assisted anterior resection for upper rectal cancer: 10-year results of a prospective, randomized trial. Dis Colon Rectum 52:558–566PubMedCrossRefGoogle Scholar
  11. 11.
    Law WL, Poon JT, Fan JK et al (2009) Comparison of outcome of open and laparoscopic resection for stage II and stage III rectal cancer. Ann Surg Oncol 16:1488–1493PubMedCrossRefGoogle Scholar
  12. 12.
    Laurent C, Leblanc F, Wütrich P et al (2009) Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg 250:54–61PubMedCrossRefGoogle Scholar
  13. 13.
    Jayne DG, Thorpe HC, Copeland J et al (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRefGoogle Scholar
  14. 14.
    Li S, Chi P, Lin H et al (2011) Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal cancer: an NTCLES study. Surg Endosc 25:3175–3182PubMedCrossRefGoogle Scholar
  15. 15.
    Liang X, Hou S, Liu H et al (2011) Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China. J Laparoendosc Adv Surg Tech A 21:381–385PubMedCrossRefGoogle Scholar
  16. 16.
    Baik SH, Gincherman M, Mutch MG et al (2011) Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum 54:6–14PubMedCrossRefGoogle Scholar
  17. 17.
    Leroy J, Jamali F, Forbes L et al (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289PubMedCrossRefGoogle Scholar
  18. 18.
    Dulucq JL, Wintringer P, Stabilini C et al (2005) Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 19:1468–1474PubMedCrossRefGoogle Scholar
  19. 19.
    Agha A, Fürst A, Hierl J et al (2008) Laparoscopic surgery for rectal cancer: oncological results and clinical outcome of 225 patients. Surg Endosc 22:2229–2237PubMedCrossRefGoogle Scholar
  20. 20.
    Pugliese R, Di Lernia S, Sansonna F et al (2008) Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases. Am J Surg 195:233–238PubMedCrossRefGoogle Scholar
  21. 21.
    Ng KH, Ng DC, Cheung HY et al (2009) Laparoscopic resection for rectal cancers: lessons learned from 579 cases. Ann Surg 249:82–86PubMedCrossRefGoogle Scholar
  22. 22.
    Milsom JW, de Oliveira O, Trencheva KI Jr et al (2009) Long-term outcomes of patients undergoing curative laparoscopic surgery for mid and low rectal cancer. Dis Colon Rectum 52:1215–1222PubMedCrossRefGoogle Scholar
  23. 23.
    Cheung HY, Ng KH, Leung AL et al (2011) Laparoscopic sphincter-preserving total mesorectal excision: 10-year report. Colorectal Dis 13:627–631PubMedCrossRefGoogle Scholar
  24. 24.
    Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312PubMedCrossRefGoogle Scholar
  25. 25.
    Wiggers T, van de Velde CJ (2002) The circumferential margin in rectal cancer. Recommendations based on the Dutch Total Mesorectal Excision Study. Eur J Cancer 38:973–976PubMedCrossRefGoogle Scholar
  26. 26.
    Franks PJ, Bosanquet N, Thorpe H et al (2006) Short-term costs of conventional vs. laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer 95:6–12PubMedCrossRefGoogle Scholar
  27. 27.
    Marijnen CA, Nagtegaal ID, Kapiteijn E et al (2003) Radiotherapy does not compensate for positive resection margins in rectal cancer patients: report of a multicenter randomized trial. Int J Radiat Oncol Biol Phys 55:1311–1320PubMedCrossRefGoogle Scholar
  28. 28.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726PubMedCrossRefGoogle Scholar
  29. 29.
    Folkesson J, Birgisson H, Pahlman L et al (2005) Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 23:5644–5650PubMedCrossRefGoogle Scholar
  30. 30.
    van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582PubMedCrossRefGoogle Scholar
  31. 31.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Oktar Asoglu
    • 1
  • Emre Balik
    • 1
    Email author
  • Enver Kunduz
    • 1
  • Sumer Yamaner
    • 1
  • Ali Akyuz
    • 1
  • Mine Gulluoglu
    • 2
  • Yersu Kapran
    • 2
  • Dursun Bugra
    • 3
  1. 1.Department of General Surgery, Istanbul Faculty of MedicineIstanbul UniversityFatih, IstanbulTurkey
  2. 2.Department of Pathology, Istanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
  3. 3.Department of General SurgeryIstanbul American HospitalIstanbulTurkey

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