Laparoscopic rectal resection with anal sphincter preservation for rectal cancer

Long-term outcome
  • J.-L. Dulucq
  • P. Wintringer
  • C. Stabilini
  • A. Mahajna
Article

Abstract

Background

Total mesorectal excision (TME) is the surgical gold standard treatment for middle and low third rectal carcinoma. Laparoscopy has gradually become accepted for the treatment of colorectal malignancy after a long period of questions regarding its safety. The purposes of this study were to examine prospectively our experience with laparoscopic TME and high rectal resections, to evaluate the surgical outcomes and oncologic adequacy, and to discuss the role of this procedure in the treatment of rectal cancer.

Methods

Between December 1992 and December 2004, all patients who underwent elective laparoscopic sphincter preserving rectal resection for rectal cancer were enrolled prospectively in this study. Data collection included preoperative, operative, postoperative and oncologic results with long-term follow-up.

Results

A total of 218 patients were operated on during the study period: 142 patients underwent laparoscopic TME and 76 patients underwent anterior resection. Of the TME patients, 122 patients were operated using the double-stapling technique, and 20 patients underwent colo-anal anastomosis with hand-sewn sutures. Mean operative time was 138 min (range, 107–205), and mean blood loss was 120 ml (range, 30–350). Conversion to open surgery occurred in 26 cases (12%). Mortality rate during the first 30 days was 1%. Anastomotic leaks were observed in 10.5% of the patients. Of these, 61.9% needed reoperation and diverting stoma, and the rest were treated conservatively. Three patients had postoperative bleeding requiring relaparoscopy. Other minor complications (infection and urinary retention) occurred in 9.1% of patients. Mean ambulation time and mean hospital stay were 1.6 days (range, 1–5) and 6.4 days (range, 3–28) , respectively. Patients were followed for a mean period of 57 months. No port site metastases were observed during follow-up. The recurrence rate was 6.8 %. Overall survival rate was 67% after 5 years and 53.5% after 10 years.

Conclusion

Laparoscopic anterior resection and TME with anal sphincter preservation for rectal cancer is feasible and safe. The short- and long-term outcomes reported in this series are comparable with those of conventional surgery.

Keywords

Laparoscopy Rectal cancer Total mesorectal excision (TME) 

References

  1. 1.
    Bockey EL, Chapuis PH, Fung C, et al. (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38: 480–487Google Scholar
  2. 2.
    Bouillot JL, Berthou JC, Champault G, et al. (2002) Elective laparoscopic colonic resection for diverticular disease results of a multicenter study in 179 patients. Surg Endosc 16: 1320–1323CrossRefPubMedGoogle Scholar
  3. 3.
    Carlsen E, Schlichtin E, Guldvog I, et al. (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85: 526–529CrossRefPubMedGoogle Scholar
  4. 4.
    Delgado S, Lacy AM, Filella X, et al. (2001) Acute phase response in laparoscopic and open colectomy in colon cancer: randomized study. Dis Colon Rectum 44: 638–646CrossRefPubMedGoogle Scholar
  5. 5.
    Delgado S, Momblan D, Salvador L, et al. (2004) Laparoscopic-assisted approach in rectal cancer patients; lesson learned from >200 patients. Surg Endosc 18: 1457–1462CrossRefPubMedGoogle Scholar
  6. 6.
    Enker WE, Laffer UT, Block GE (1979) Enhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 190: 350–360PubMedGoogle Scholar
  7. 7.
    Enker WE, Thaler HT, Cranor ML, et al. (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181: 335–346PubMedGoogle Scholar
  8. 8.
    Franklin MEJ, Rosenthal D, Abrego-Medina, et al. (1996) Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five years results. Dis Colon Rectum 39: S35–S46Google Scholar
  9. 9.
    Hartley JE, Mehigan BJ, Qureshi AE, et al. (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44: 315–321CrossRefPubMedGoogle Scholar
  10. 10.
    Havenga K, Enker WE, Norstein J, et al. (1999) Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 25: 368–374CrossRefPubMedGoogle Scholar
  11. 11.
    Hazebroek EJ, for the Color Study Group (2002) COLOR: a randomized trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16: 949–953PubMedGoogle Scholar
  12. 12.
    Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69: 613–616PubMedGoogle Scholar
  13. 13.
    Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16: 848–857CrossRefPubMedGoogle Scholar
  14. 14.
    Heald RJ, Moran BJ, Ryall RD, et al. (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision 1978–1997. Arch Surg 133: 894–899PubMedGoogle Scholar
  15. 15.
    Heald RJ, Smedh RK, Kald A, Sexton R, Moran BJ (1997) Abdominoperineal excision of the rectum—an endangered operation. Dis Colon Rectum 40: 747–751CrossRefPubMedGoogle Scholar
  16. 16.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. (2001) Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for respectable rectal cancer. N Engl J Med 345: 638–646CrossRefPubMedGoogle Scholar
  17. 17.
    Kockerling F, Schneider C, Reymond MA, et al. (1999) Laparoscopic resection of sigmoid diverticulitis results of a multicenter study Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13: 567–571PubMedGoogle Scholar
  18. 18.
    Kohler L (1999) Endoscopic surgery: what has passed the test? World J Surg 23: 816–824PubMedGoogle Scholar
  19. 19.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurà P, Piquè JM, Visa J (2002) Laparoscopy assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229CrossRefPubMedGoogle Scholar
  20. 20.
    Lacy AM, Garcia-Valdecasas JC, Pique JM (1995) Short term outcome analysis of a randomised study comparing laparoscopic versus open colectomy for colon cancer. Surg Endosc 9: 1101–1105PubMedGoogle Scholar
  21. 21.
    Landis SH, Murray T, Bolden S, et al. (1998) Cancer statistics. CA Cancer J Clin 48: 6–29PubMedCrossRefGoogle Scholar
  22. 22.
    Lau Leung K, Kwok S, Lam S, Lee J, Yiu R, Ng S, Lai P (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363: 1187–1192Google Scholar
  23. 23.
    Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery. Surg Endosc 18: 281–289PubMedGoogle Scholar
  24. 24.
    McAnena OJ, Heald RJ, Lokhart-Mummery HE (1990) Operative and functional results of total mesorectal excision with ultra-low anterior resection in the management of carcinoma of the lower one-third of the rectum. Surg Gynecol Obstet 170: 517–521PubMedGoogle Scholar
  25. 25.
    Morino M, Parini U, Giraudo G, Salval M, Brachet R, Garrone C (2003) Laparoscopic total mesorectal excision. A consecutive series of 100 patients. Ann Surg 237: 335–342Google Scholar
  26. 26.
    Parks AG, Percy JP (1982) Resection and sutured coloanal anastomosis for rectal carcinoma. Br J Surg 69: 301–304PubMedGoogle Scholar
  27. 27.
    Quirke P (2003) Training and quality assurance for rectal cancer: 20 years of data is enough Lancet Oncol 4: 695–792CrossRefPubMedGoogle Scholar
  28. 28.
    Schiedeck T, Schwandner O, Baca I, et al. (2000) Laparoscopic surgery for the cure of colorectal surgery: results of a German five-center study. Dis Colon Rectum 43: 1–8CrossRefPubMedGoogle Scholar
  29. 29.
    Schiedeck T, Schwandner O, Bruch HP (1998) Laparoscopic sigmoid resection for diverticulitis. Chirug 69: 846–853Google Scholar
  30. 30.
    Schwenk W, Bohm B, Muller JM (1998) Postoperative pain and fatigue after laparoscopic or conventional colorectal resections; a prospective randomised trial. Surg Endosc 12: 1131–1136PubMedGoogle Scholar
  31. 31.
    Simunovic M, Sexton R, Rempel E, et al. (2003) Optimal preoperative assessment and surgery for rectal cancer may greatly limit the need for radiotherapy. Br J Surg 90: 999–1003CrossRefPubMedGoogle Scholar
  32. 32.
    Weeks JC, Nelson H, Gelber S, et al. (2002) Short term quality of life outcomes following laparoscopic assisted colectomy versus open colectomy for colon cancer: a randomised trial. J Am Med Assoc 287: 321–328Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • J.-L. Dulucq
    • 1
  • P. Wintringer
    • 1
  • C. Stabilini
    • 1
  • A. Mahajna
    • 1
  1. 1.Department of Abdominal SurgeryMaison de Santé Protestante, Bagatelle HospitalTalence-BordeauxFrance

Personalised recommendations