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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
Article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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.

Notes

Acknowledgments

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.

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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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