Surgical Endoscopy

, 23:113 | Cite as

Results of a multicenter study of 1,057 cases of rectal cancer treated by laparoscopic surgery

  • Nobuyoshi MiyajimaEmail author
  • Masaki Fukunaga
  • Hirotoshi Hasegawa
  • Jun-ichi Tanaka
  • Junji Okuda
  • Masahiko Watanabe
  • On Behalf of Japan Society of Laparoscopic Colorectal Surgery



The aim of this study was to clarify the feasibility of laparoscopic surgery for rectal cancer retrospectively in 28 centers throughout Japan.


Between May 1994 and February 2006, 1,057 selected patients with rectal cancer underwent laparoscopic surgery. All the data regarding the patient details, and operative and postoperative outcome were collected retrospectively.


Mean follow-up was 30 months. Procedures included anterior resection in 938, abdominoperineal resection in 107, Hartmann’s procedure in 10, and others in two patients. Conversion to open procedures occurred in 77 patients (7.3%). Postoperative surgical complications developed in 235 patients (22.2%), including anastomotic leakage in 84 (9.1%). Median length of postoperative hospital stay was 15 days (7–271 days). Patients with upper rectal cancer had shorter hospital stay than those with lower rectal cancer (14 versus 18 days, p < 0.01). Tumor–node–metastases (TNM) stage included 83(7.9%) stage 0, 495 (46.8%) stage I, 197 (18.6%) stage II, 230 (21.8%) stage III, and 52 (4.9%) stage IV. Recurrence was developed in 67 patients (6.6%) of the 1,011 curatively treated patients. Local recurrence occurred in 11 patients (1.0%). There was no port-site metastasis. Of the 1,011 curatively treated patients, the 3-year disease-free survival rate was 100% in stage 0, 94.6% in stage I, 82.1% in stage II, and 79.7% in stage III.


Laparoscopic surgery is feasible and safe in selected patients with rectal cancer, with favorable short-term and mid-term outcome.


Rectal cancer Laparoscopic surgery Short-term outcome Multicenter study 



This study was supported in part by Japanese Society for Cancer of the Colon and Rectum. The following surgeons and institutions participated in this multicenter study initiated by the Japan Society of Laparoscopic Colorectal Surgery: Masahiko Watanabe, Yukihito Kokuba, Kitasato University (Sagamihara); Fumio Konishi, Yutaka Kawamura, Omiya Medical Center Jichi Medical School (Omiya); Nobuyoshi Miyajima, Teikyo University Hospital Mizonokuchi (Kawasaki); Masaki Fukunaga, Juntendo Urayasu Hospital Juntendo University School of Medicine (Urayasu); Shinei Kudo, Junichi Tanaka, Northern Yokohama Hospital Showa University (Yokohama); Nobuhiko Tanigawa, Junji Okuda, Osaka Medical University (Osaka); Hideo Nagai, Hisanaga Horie Jichi Medical School (Tochigi); Koki Otsuka, Iwate Medical University (Sendai); Yosuke Fukunaga, Osaka City Genaral Hospital (Osaka); Masazumi Okajima, Hiroshima University Graduate School of Biomedical Sciences (Hiroshima); Hiroyuki Bandou, Ishikawa Prefectural Central Hospital (Kanazawa); Seigo Kitano, Masafumi Inomata, Oita University Faculty of Medicine, Yoshiro Kubo, Shikoku Cancer Center (Matsuyama); Takao Ichihara, Nishinomiya Municipal Central Hospital (Nishinomiya); Hirotoshi Hasegawa, Keio University School of Medicine (Tokyo); Seiichiro Yamamoto, National Cancer Center (Tokyo); Shigeru Ikoma, Ikoma Hospital (Kagoshima); Yasuhiko Nishiyama, National Hospital Organization Sagamihara National Hospital (Sagamihara); Kenichi Sugihara, Masayuki Enomoto, Tokyo Medical and Dental University Graduate School (Tokyo); Shigeki Yamaguchi, Shizuoka Cancer Center (Shizuoka); Mitsugu Sekimoto, Osaka University Graduate School of Medicine, Masahiko Masaki, Kyorin University (Tokyo); Hitoshi Idani, Fukuyama City Hospital (Fukuyama); Yoshinobu Sumiyama, Yoshihisa Saida, Ohashi Hospital Toho University School of Medicine (Tokyo); Yoshinori Munemoto, Fukui Saiseikai Hospital (Fukui); Kotaro Maeda, Koichi Hanai, Fujita Health University (Toyoake); Hiroya Kuroyanagi, The Cancer Institute Hospital of JFCR (Tokyo); Kazuki Ueda, Kinki University (Osaka).


  1. 1.
    Anthuber M, Fuerst A, Elser F, Berger R, Jauch K-W (2003) Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum 46:1047–1053PubMedCrossRefGoogle Scholar
  2. 2.
    Barlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer. Surg Endosc 19:757–766PubMedCrossRefGoogle Scholar
  3. 3.
    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 85:526–529PubMedCrossRefGoogle Scholar
  4. 4.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Eng J Med 350:2050-2059.Google Scholar
  5. 5.
    Delgado S, Momblan D, Salvador L, Bravo R, Castells A, Ibarzabal A, Pique JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients: lessons learned from >200 patients. Surg Endosc 18:1457–1462PubMedCrossRefGoogle Scholar
  6. 6.
    Dennis H, Jeanine T, Mehran A (2001) Laparoscopic vs. open resection for colorectal adenocarcinoma. Dis Colon Rectum 44:10–19Google Scholar
  7. 7.
    Enker WE, Thaler HT, Cranor ML, Polyak T (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMedGoogle Scholar
  8. 8.
    Falk PM, Beart RW Jr, Wexner SD, Thorson AG, Jagelman DG, Lavery IC, Johansen OB, Fitzgibbons RJ Jr (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36:28–34PubMedCrossRefGoogle Scholar
  9. 9.
    Franklin ME Jr, Rosenthal D, Abrego-Medina D, Dorman JP, Glass JL, Norem R, Diaz A (1996) Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 39:S35–S46Google Scholar
  10. 10.
    Goldberg S, Klas JV (1998) Total mesorectal excision in the treatment of rectal cancer: a view from the USA. Semin Surg Oncol 15:87–90PubMedCrossRefGoogle Scholar
  11. 11.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM for the MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial); multicentre, randomised controlled trial. Lancet 365: 1718–1726.Google Scholar
  12. 12.
    Hainsworth PJ, Egan MJ, Cunliffe WJ (1997) Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84:652–656PubMedCrossRefGoogle Scholar
  13. 13.
    Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16:848–857PubMedCrossRefGoogle Scholar
  14. 14.
    Ishii Y, Hasegawa H, Nishibori H, Endo T, Kitajima M (2006) The application of a new stapling device for open surgery (Contour(TM) Curved Cutter Stapler) in the laparoscopic resection of rectal cancer. Surg Endosc. 20:1329–1331PubMedCrossRefGoogle Scholar
  15. 15.
    Japanese Society for Cancer of the Colon and Rectum. General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus, 6th edn (in Japanese) (1998). Kanehara, Tokyo, JapanGoogle Scholar
  16. 16.
    Khallili TM, Fleshner PR, Hiatt JR, Sokol TP, Manookian C, Tsushima G, Phillips EH (1998) Colorectal cancer: comparison of laparoscopic with open approaches. Dis Colon Rectum 41:832–838CrossRefGoogle Scholar
  17. 17.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  18. 18.
    Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J (2004) Laparoscopic total mesorectal excision (TME) after rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289PubMedCrossRefGoogle Scholar
  19. 19.
    Leung KL, KwokSPY Lam SCW, Lee JFY, Yiu RYC, Ng SSM, Lai PBS (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 363:1187–1192PubMedCrossRefGoogle Scholar
  20. 20.
    Morino M, Parini U, Giraudo G, Salval M, Brachet CR, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342PubMedCrossRefGoogle Scholar
  21. 21.
    Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJ; Dutch Colorectal Cancer Group (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216Google Scholar
  22. 22.
    Poulin EC, Mamazza J, Schlachta CM, Gregoire R, Roy N (1999) Laparoscopic resection does not adversely affect early survival curves in patients undergoing surgery for colorectal adenocarcinoma. Ann Surg 229:487–492PubMedCrossRefGoogle Scholar
  23. 23.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358PubMedCrossRefGoogle Scholar
  24. 24.
    Scheidbach H, Schneider C, Konradt J, Barelehner E, Kohler L, Wittekind Ch, Kockerling F (2002) Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc 16:7–13PubMedCrossRefGoogle Scholar
  25. 25.
    Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82:295–298PubMedCrossRefGoogle Scholar
  26. 26.
    Yamamoto S, Watanabe M, Hasegawa H, Kitajima M (2002) Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum 45:1648–1654PubMedCrossRefGoogle Scholar
  27. 27.
    Young-Fadok TM, Radice E, Nelson H, Harmsen WS (2000) Benefits of laparoscopic-assisted colectomy for colon polyps: a case-matched series. Mayo Clin Proc 75:344–348PubMedCrossRefGoogle Scholar
  28. 28.
    Zaheer S, Pemberton JH, Frouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nobuyoshi Miyajima
    • 1
    Email author
  • Masaki Fukunaga
    • 2
  • Hirotoshi Hasegawa
    • 3
  • Jun-ichi Tanaka
    • 4
  • Junji Okuda
    • 5
  • Masahiko Watanabe
    • 6
  • On Behalf of Japan Society of Laparoscopic Colorectal Surgery
    • 7
  1. 1.Department of Gastroenterological and General SurgerySt. Marianna University Toyoko HospitalKawasakiJapan
  2. 2.Department of SurgeryJuntendo University Urayasu HospitalChibaJapan
  3. 3.Department of SurgeryKeio UniversityTokyoJapan
  4. 4.Digestive Disease Center, Showa University Northern Yokohama HospitalKanagawaJapan
  5. 5.Department of SurgeryOsaka Medical UniversityOsakaJapan
  6. 6.Department of SurgeryKitasato UniversityKanagawaJapan
  7. 7.KanagawaJapan

Personalised recommendations