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Surgical Endoscopy

, 25:1753 | Cite as

Laparoscopic total mesorectal excision following long course chemoradiotherapy for locally advanced rectal cancer

  • Roger W. Motson
  • J. S. Khan
  • T. H. A. Arulampalam
  • R. C. T. Austin
  • N. Lacey
  • B. Sizer
Article

Abstract

Purpose

Laparoscopic total mesorectal excision (TME) of locally advanced rectal cancer after long-course chemoradiotherapy (LCRT) is surgically and oncologically challenging. We have assessed the feasibility, timing, and short-term oncological outcome of laparoscopic TME after LCRT.

Methods

Between 2004 and 2006, 30 patients were selected for LCRT based on clinical examination and MRI. Patients received 3/4 field radiotherapy, 45–50.4 Gy in 25–28 fractions during 5 weeks with either 5-fluorouracil or Uftoral. Clinical assessments were made 4 weeks after completion of radiotherapy and then 2 weekly with sequential 4 weekly MRI, to individualize the timing of surgery at maximal response. Laparoscopic TME was performed using a standard technique.

Results

Thirty patients received LCRT and 26 patients (21 men; median age, 63 years) underwent laparoscopic TME at 11 weeks (median) after LCRT. Median operating time was 270 min. Sixteen patients had LAR and ten had APR. There were three conversions. Three patients developed anastomotic leak (18.7%): one was managed conservatively and one patient died of septicemia. Morbidity was seen in 19% of patients. There were 25 (96%) R0 resections with a complete response in 5 (19%) cases and microscopic tumor in lakes of mucin (Tmic) in another 6 (23%). Two patients (7.6%) developed local recurrence (median follow up, 34 months). The median time interval between radiotherapy and surgery was 11 (range, 7–13) weeks, which was based on serial MRI scans after LCRT.

Conclusions

Laparoscopic TME after LCRT is feasible and safe both oncologically and surgically. Serial MRI helps to determine the optimum timing of surgery.

Keywords

Laparoscopic total mesorectal excision Locally advanced rectal cancer Long-course chemoradiotherapy 

Notes

Acknowledgment

The authors wish to acknowledge the support of Mrs Jane Bradley-Hendricks and Professor John Norton in writing this manuscript.

Disclosures

R. W. Motson, J. S. Khan, T. H. A. Arulampalam, R. C. T Austin, N. Lacey, and B. Sizer have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Roger W. Motson
    • 1
  • J. S. Khan
    • 1
  • T. H. A. Arulampalam
    • 1
  • R. C. T. Austin
    • 1
  • N. Lacey
    • 1
  • B. Sizer
    • 1
  1. 1.The ICENI Centre, Colchester General HospitalColchesterUK

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