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Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: Long-term results

Abstract

The long-term role of laparoscopy in the treatment of rectal cancer is still controversial. The aim of the present study was to evaluate the safety, the feasibility, the perioperative outcome, and the long-term results of laparoscopic total mesorectal excision (TME) for extraperitoneal rectal cancer considering a single center series.

Methods

Data about 186 unselected consecutive patients that underwent laparoscopic TME for middle and low rectal cancer between January 2001 and December 2011 were prospectively recorded and were included in the present study.

Results

Distribution of TNM stage was 5 % T1, 37 % T2, 52.5 % T3, and 6 % T4. Fifty-one percent of patients have lymph node metastases. The average duration of surgery was 234 min. Fourteen patients required conversion (7.5 %). A complete microscopic excision was achieved in 169 patients (91 %). The mean hospital stay was 9 days. The overall postoperative morbidity rate was 24 %. Surgical-related complications were reported in 19 %. Overall mortality was 0.5 %. Sex, tumor level, and the presence of a stoma were the only statistically significant independent risk factors for anastomotic leakage. Median follow-up was 71 months. The 5-year overall survival rate was 77 %, with 89 % for stage 1, 81 % for stage 2, 43 % for stage 3, and 10 % for stage 4. The 5-year disease-free survival rate was 66 %. The 10-year survival rate was 54 %. Nine patients (4.8 %) experienced a pelvic recurrence. Late metastases developed in 31 patients (17.2 %).

Conclusions

The study confirms the oncological safety of laparoscopic TME in a long follow-up period.

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Conflict of interest

The authors have no potential conflict of interest or financial ties to be disclosed.

Contribution

JM, CB, PT, AT, and AV contributed to study conception and design. JM, CB, AB, and PP contributed to the acquisition of data. JM, CB, and AV contributed to the analysis and interpretation of data. JM and CB contributed to the writing of the manuscript.

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Correspondence to Jacopo Martellucci.

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Martellucci, J., Bergamini, C., Bruscino, A. et al. Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: Long-term results. Int J Colorectal Dis 29, 1493–1499 (2014). https://doi.org/10.1007/s00384-014-2017-5

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Keywords

  • Rectal cancer
  • Laparoscopy
  • Total mesorectal excision
  • Laparoscopic total mesorectal excision
  • Anterior resection
  • Laparoscopic resection