Skip to main content

Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes

Surgical Endoscopy And Other Interventional Techniques volume 18, pages 281–289 (2004)Cite this article

Abstract

Background: Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. However, the laparoscopic approach to resection for colorectal cancer remains controversial due to fears that oncologic principles will be compromised. We assessed the feasibility, safety and long-term outcome of laparoscopic rectal cancer resections following the principles of TME. The aim of this study was to evaluate the perioperative outcome and long-term results of laparoscopic TME. Methods: We reviewed the prospective database of 102 consecutive unselected patients undergoing laparoscopic TME for rectal cancer between November 1991 and December 2000. Follow-up was done through office charts or direct patient contact. Recurrence and survival curves were generated by the Kaplan-Meier method. Results: Laparoscopic TME was completed successfully in 99 patients, whereas conversion to an open approach was required in three cases (3%). The overall morbidity and mortality rates were 27% and 2%, respectively, with an overall anastomotic leak rate of 17%. Of the 102 patients, four were excluded from the oncologic evaluation because final pathology was not confirmatory (two had anal canal squamous cell carcinoma and two had villous adenoma with dysplasia). In 90 of the 98 remaining patients (91.8%), the resection was considered curative. The remainder had a palliative resection due to synchronous metastatic disease or locally advanced disease. Mean follow-up was 36 months (range, 6–96). There were no trocar site recurrences. The local recurrence rate was 6%, and the cancer-specific survival of all curatively resected patients was 75% at 5 years. The overall survival rate of all curatively resected patients was 65% at 5 years; mean survival time was 6.23 years (95% confidence interval [CI], 5.39–7.07). Conclusion: Laparoscopic TME is feasible and safe. The laparoscopic approach to the surgical treatment of operable rectal cancer does not seem to entail any oncologic disadvantages.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2
Figure 3

References

  1. FJ Berends G Kazemier HJ Bonjer JF Lange (1994) ArticleTitleSubcutaneous metastases after laparoscopic colectomy [Letter]. Lancet 344 58 Occurrence Handle10.1016/S0140-6736(94)91079-0 Occurrence Handle1:STN:280:ByuB1crmtFA%3D

    Article  CAS  Google Scholar 

  2. KF Birbeck CP Macklin NJ Tiffin W Parsons MF Dixon NP Mapstone CR Abbott N Scott PJ Finan D Johnston et al. (2002) ArticleTitleRates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 235 449–457 Occurrence Handle10.1097/00000658-200204000-00001 Occurrence Handle11923599

    Article  PubMed  Google Scholar 

  3. E Carlsen E Schlichting I Guldvog E Johnson RJ Heald (1998) ArticleTitleEffect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85 526–529 Occurrence Handle1:STN:280:DyaK1c3mvVGmtA%3D%3D Occurrence Handle9607540

    CAS  PubMed  Google Scholar 

  4. WE Enker UT Laffer GE Block (1979) ArticleTitleEnhanced survival of patients with colon and rectal cancer is based upon wide anatomic resection. Ann Surg 190 350–360 Occurrence Handle1:STN:280:Bi%2BD3MbjsFQ%3D Occurrence Handle485609

    CAS  PubMed  Google Scholar 

  5. WE Enker HT Thaler ML Cranor T Polyak (1995) ArticleTitleTotal mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181 335–346 Occurrence Handle1:STN:280:BymD3cfkslU%3D Occurrence Handle7551328

    CAS  PubMed  Google Scholar 

  6. B Fisher N Wolmark H Rockette C Redmond M Deutsch DL Wickerham ER Fisher R Caplan J Jones H Lerner et al. (1988) ArticleTitlePostoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 80 21–29 Occurrence Handle1:STN:280:BieC3MbgtVc%3D Occurrence Handle3276900

    CAS  PubMed  Google Scholar 

  7. InstitutionalAuthorNameGastrointestinal Tumor Study Group (1984) ArticleTitleAdjuvant therapy of colon cancer—results of a prospectively randomized trial. N Engl J Med 22, 310 737–743

    Google Scholar 

  8. InstitutionalAuthorNameGastrointestinal Tumor Study Group (1985) ArticleTitleProlongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med 312 1465–1472 Occurrence Handle2859523

    PubMed  Google Scholar 

  9. S Goldberg JV Klas (1998) ArticleTitleTotal mesorectal excision in the treatment of rectal cancer: a view from the USA. Semin Surg Oncol 15 87–90 Occurrence Handle10.1002/(SICI)1098-2388(199809)15:2<87::AID-SSU5>3.0.CO;2-1 Occurrence Handle1:STN:280:DyaK1czpvVWrsA%3D%3D Occurrence Handle9730414

    Article  CAS  PubMed  Google Scholar 

  10. PJ Hainsworth MJ Egan WJ Cunliffe (1997) ArticleTitleEvaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 84 652–656 Occurrence Handle1:STN:280:ByiA3MrnsV0%3D Occurrence Handle9171754

    CAS  PubMed  Google Scholar 

  11. O Hallbook L Pahlman M Krog SD Wexner R Sjodahl (1996) ArticleTitleRandomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224 58–65 Occurrence Handle8678619

    PubMed  Google Scholar 

  12. JE Hartley BJ Mehigan AE Qureshi GS Duthie PW Lee JR Monson (2001) ArticleTitleTotal mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44 315–321 Occurrence Handle1:STN:280:DC%2BD3M7pvFyktw%3D%3D Occurrence Handle11289275

    CAS  PubMed  Google Scholar 

  13. K Havenga WE Enker J Norstein Y Moriya RJ Heald HC van Houwelingen CJ van de Velde (1999) ArticleTitleImproved 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 25 368–374 Occurrence Handle10.1053/ejso.1999.0659 Occurrence Handle1:STN:280:DyaK1MzltValug%3D%3D Occurrence Handle10419706

    Article  CAS  PubMed  Google Scholar 

  14. RJ Heald ND Karanjia (1992) ArticleTitleResults of radical surgery for rectal cancer. World J Surg 16 848–857 Occurrence Handle1:STN:280:ByyD1MjntFI%3D Occurrence Handle1462619

    CAS  PubMed  Google Scholar 

  15. RJ Heald EM Husband RD Ryall (1982) ArticleTitleThe mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69 613–616 Occurrence Handle1:STN:280:BiyD38zpsVU%3D Occurrence Handle6751457

    CAS  PubMed  Google Scholar 

  16. RJ Heald BJ Moran RD Ryall R Sexton JK MacFarlane (1998) ArticleTitleRectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133 894–899 Occurrence Handle1:STN:280:DyaK1cznsFOrsQ%3D%3D Occurrence Handle9711965

    CAS  PubMed  Google Scholar 

  17. P Hermanek H Wiebelt D Staimmer S Riedl (1995) ArticleTitlePrognostic factors of rectum carcinoma—experience of the German Multicentre Study SGCRC: German Study Group Colo-Rectal Carcinoma . Tumori 81 IssueID3 Suppl 60–64 Occurrence Handle1:STN:280:BymD3MvgtVM%3D Occurrence Handle7571056

    CAS  PubMed  Google Scholar 

  18. PJ Hewett WM Thomas G King M Eaton (1996) ArticleTitleIntraperitoneal cell movement during abdominal carbon dioxide insufflation and laparoscopy: an in vivo model. Colon Rectum 39 IssueID10 Suppl S62–S66 Occurrence Handle1:STN:280:BymH38fksVI%3D Occurrence Handle8831549

    CAS  PubMed  Google Scholar 

  19. TT Irvin JC Goligher (1973) ArticleTitleAetiology of disruption of intestinal anastomoses. Br J Surg 60 461–464

    Google Scholar 

  20. E Kapiteijn CJ van De Velde (2000) ArticleTitleEuropean trials with total mesorectal excision. Semin Surg Oncol 19 350–357 Occurrence Handle10.1002/ssu.5.abs Occurrence Handle1:STN:280:DC%2BD3MzitlCqtA%3D%3D Occurrence Handle11241917

    Article  CAS  PubMed  Google Scholar 

  21. E Kapiteijn EK Kranenbarg WH Steup CW Taat HJ Rutten T Wiggers JH van Krieken J Hermans JW Leer CJ van de Velde (1999) ArticleTitleTotal mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer: prospective randomised trial with standard operative and histopathological techniques: Dutch ColoRectal Cancer Group . Eur J Surg 165 410–420 Occurrence Handle10.1080/110241599750006613 Occurrence Handle1:STN:280:DyaK1MzhvVSguw%3D%3D Occurrence Handle10391155

    Article  CAS  PubMed  Google Scholar 

  22. SH Kim JW Milsom TL Gramlich SM Toddy GI Shore J Okuda VW Fazio (1998) ArticleTitleDoes laparoscopic vs. conventional surgery increase exfoliated cancer cells in the peritoneal cavity during resection of colorectal cancer? Dis Colon Rectum 41 971–978 Occurrence Handle1:STN:280:DyaK1czotVyrsQ%3D%3D Occurrence Handle9715151

    CAS  PubMed  Google Scholar 

  23. AM Lacy JC Garcia-Valdecasas JM Pique S Delgado E Campo JM Bordas P Taura L Grande J Fuster JL Pacheco et al. (1995) ArticleTitleShort-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9 1101–1105

    Google Scholar 

  24. AM Lacy S Delgado JC Garcia-Valdecasas A Castells JM Pique L Grande J Fuster EM Targarona M Pera J Visa (1998) ArticleTitlePort site metastases and recurrence after laparoscopic colectomy: a randomized trial. Surg Endosc 12 1039–1042

    Google Scholar 

  25. SA Lord SW Larach A Ferrara PR Williamson CP Lago MW Lube (1996) ArticleTitleLaparoscopic resections for colorectal carcinoma: a three-year experience. Dis Colon Rectum 39 148–154 Occurrence Handle1:STN:280:BymB38znt1I%3D Occurrence Handle8620780

    CAS  PubMed  Google Scholar 

  26. J Marescaux J Leroy M Gagner F Rubino D Mutter M Vix SE Butner MK Smith (2001) ArticleTitleTransatlantic robot-assisted telesurgery. Nature 413 379–380 Occurrence Handle10.1038/35096636 Occurrence Handle1:CAS:528:DC%2BD3MXntl2htbs%3D Occurrence Handle11574874

    Article  CAS  PubMed  Google Scholar 

  27. J Marescaux F Rubino J Leroy M Henri (2002) ArticleTitleLaparoscopic assisted surgery for colon cancer [Letter]. JAMA 287 15

    Google Scholar 

  28. AL Martling T Holm LE Rutqvist BJ Moran RJ Heald B Cedemark (2000) ArticleTitleEffect of a surgical training programme on outcome of rectal cancer in the county of Stockholm: Stockholm Colorectal Cancer Study Group , Basingstoke Bowel Cancer Research Project. Lancet 8, 356 93–96

    Google Scholar 

  29. OJ McAnena RJ Heald HE Lockhart-Mummery (1990) ArticleTitleOperative 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 170 517–521 Occurrence Handle1:STN:280:By%2BB28%2FnsVc%3D Occurrence Handle1693016

    CAS  PubMed  Google Scholar 

  30. CS McArdle D Hole (1991) ArticleTitleImpact of variability among surgeons on postoperative morbidity and mortality and ultimate survival. BMJ 302 1501–1505 Occurrence Handle1:STN:280:By6A3cfnsVM%3D Occurrence Handle1713087

    CAS  PubMed  Google Scholar 

  31. JW Milsom B Bohm KA Hammerhofer V Fazio E Steiger P Elson (1998) ArticleTitleA prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 187 46–54 Occurrence Handle1:STN:280:DyaK1czitFClsw%3D%3D Occurrence Handle9660024

    CAS  PubMed  Google Scholar 

  32. JW Moore EL Bokey RC Newland PH Chapuis (1996) ArticleTitleLymphovascular clearance in laparoscopically assisted right hemicolectomy is similar to open surgery. Aust N Z J Surg 66 605–607 Occurrence Handle1:STN:280:ByiD3M3jsVE%3D Occurrence Handle8859160

    CAS  PubMed  Google Scholar 

  33. M Murty WE Enker J Martz (2000) ArticleTitleCurrent status of total mesorectal excision and autonomic nerve preservation in rectal cancer. Semin Surg Oncol 19 321–328 Occurrence Handle10.1002/ssu.2 Occurrence Handle1:STN:280:DC%2BD3MzitlCqsQ%3D%3D Occurrence Handle11241914

    Article  CAS  PubMed  Google Scholar 

  34. BM Philipson EL Bokey JW Moore PH Chapuis E Bagge (1997) ArticleTitleCost of open versus laparoscopically assisted right hemicolectomy for cancer. World J Surg 21 214–217 Occurrence Handle10.1007/s002689900219 Occurrence Handle1:STN:280:ByiC2M3jsVI%3D Occurrence Handle8995082

    Article  CAS  PubMed  Google Scholar 

  35. P Quirke P Durdey MF Dixon NS Williams (1986) ArticleTitleLocal recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 2 996–999 Occurrence Handle10.1016/S0140-6736(86)92612-7 Occurrence Handle1:STN:280:BiiD3sfjslU%3D Occurrence Handle2430152

    Article  CAS  PubMed  Google Scholar 

  36. JV Reynolds WP Joyce J Dolan K Sheahan JM Hyland (1996) ArticleTitlePathological evidence in support of total mesorectal excision in the management of rectal cancer. Br J Surg 83 1112–1115

    Google Scholar 

  37. F Rubino L Soler J Marescaux H Maisonneuve (2002) ArticleTitleAdvances in virtual reality are wide ranging. BMJ 324 612 Occurrence Handle10.1136/bmj.324.7337.612

    Article  Google Scholar 

  38. RM Satava (2001) ArticleTitleSurgical education and surgical simulation. World J Surg 25 1484–1489 Occurrence Handle10.1007/s00268-001-0134-0 Occurrence Handle1:STN:280:DC%2BD38%2FjtlSlsg%3D%3D Occurrence Handle11760753

    Article  CAS  PubMed  Google Scholar 

  39. JG Stage S Schulze P Moller H Overgaard M Andersen VB Rebsdorf-Pedersen HJ Nielsen (1997) ArticleTitleProspective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 84 391–396 Occurrence Handle1:STN:280:ByiB3s3htl0%3D Occurrence Handle9117320

    CAS  PubMed  Google Scholar 

  40. L Stocchi H Nelson (2000) ArticleTitleWound recurrences following laparoscopic-assisted colectomy for cancer. Arch Surg 135 948–958 Occurrence Handle10.1001/archsurg.135.8.948 Occurrence Handle1:STN:280:DC%2BD3cvhs12rtw%3D%3D Occurrence Handle10922258

    Article  CAS  PubMed  Google Scholar 

  41. H Tomita PW Marcello JW Milsom (1999) ArticleTitleLaparoscopic surgery of the colon and rectum. World J Surg 23 397–405 Occurrence Handle1:STN:280:DyaK1M7lsFeisQ%3D%3D Occurrence Handle10030864

    CAS  PubMed  Google Scholar 

  42. MF van Driel WC Weymar Schultz HB van de Wiel DE Hahn HJ Mensink (1993) ArticleTitleFemale sexual functioning after radical surgical treatment of rectal and bladder cancer. Eur J Surg Oncol 19 183–187 Occurrence Handle1:STN:280:ByyB2Mbjt1U%3D Occurrence Handle8491323

    CAS  PubMed  Google Scholar 

  43. JC Weeks H Nelson S Gelber D Sargent G Schroeder (2002) ArticleTitleShort-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287 321–328 Occurrence Handle11790211

    PubMed  Google Scholar 

  44. MR Weiser JW Milsom (2000) ArticleTitleLaparoscopic total mesorectal excision with autonomic nerve preservation. Semin Surg Oncol 19 396–403 Occurrence Handle10.1002/ssu.10 Occurrence Handle1:STN:280:DC%2BD3MzitlGjsw%3D%3D Occurrence Handle11241922

    Article  CAS  PubMed  Google Scholar 

  45. SD Wexner SM Cohen A Ulrich P Reissman (1995) ArticleTitleLaparoscopic colorectal surgery—are we being honest with our patients? Dis Colon Rectum 38 723–727 Occurrence Handle1:STN:280:ByqA3s7gvVU%3D Occurrence Handle7607032

    CAS  PubMed  Google Scholar 

  46. S Zaheer JH Pemberton R Farouk RR Dozois BG Wolff D Ilstrup (1998) ArticleTitleSurgical treatment of adenocarcinoma of the rectum. Ann Surg 227 800–811 Occurrence Handle1:STN:280:DyaK1c3pvFKmtA%3D%3D Occurrence Handle9637543

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. IRCAD–European Institute of Telesurgery (IRCAD-EITS), Louis Pasteur University, 1 Place de l’Hopital, 67091 Strasbourg, France

    J. Leroy, F. Jamali, L. Forbes, M. Smith, F. Rubino, D. Mutter & J. Marescaux

Authors
  1. J. Leroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Jamali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Forbes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Rubino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Mutter
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Marescaux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Marescaux.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Leroy, J., Jamali, F., Forbes, L. et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18, 281–289 (2004). https://doi.org/10.1007/s00464-002-8877-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-8877-8

Keywords

  • Laparoscopy
  • Total mesorectal excision (TME)
  • Rectal cancer
  • Colorectal disease
  • Cancer