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Laparoscopic TME: Better Vision, Better Results?

  • Conference paper
Rectal Cancer Treatment

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 165))

Abstract

One of the most controversial discussions on laparoscopic surgery deals with the question of whether to apply this technique to malignant disease and specifically to rectal cancer. The four major issues are the adequacy of oncologic resection, recurrence rates and patterns, long-term survival and quality of life. There is evidence, from nonrandomized studies, suggesting that margins of excision and lymph node harvest achieved laparoscopically reached comparable results to those known from conventional open resection. Our own experience of laparoscopic surgery on rectal cancer is based on 52 patients treated with curative intent. Focusing on the postoperative long-term run, we gained the following results: The median age of patients was 66.7 years and ranged from 42–88. Anastomotic leakage was seen in 6.1% of cases. In a median follow-up of 48 months (36–136), we reached an overall 3-year survival rate of 93% and a 5-year survival rate of 62%. Local recurrence was 1.9%, distant metastasis occurred in 11.5% of cases. We saw no port-site metastasis. To evaluate functional results following laparoscopic surgery a matched pair analysis was carried out. Matching of patients after laparoscopic and conventional open surgery was performed according to sex, age, type of resection, time period of surgery, and stage of disease classified by UICC. Regarding bladder and sexual dysfunction, using the EORTC QLQ CR38 score we found no statistical significant difference between the examined groups. As far as can be seen, laparoscopic surgery in rectal carcinoma may achieve the same or, in selected patients, even better results than open surgery. However, at present no published study has shown much evidence. Many more studies are necessary to define the place of laparoscopic technique in rectal cancer surgery, regarding appropriate selection of patients and evaluating adjuvant or neoadjuvant treatment in combination with the laparoscopic approach.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Clinic Ludwigsburg, Posilipostr. 4, 71631, Ludwigsburg, Germany

    T. H. K. Schiedeck

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  1. T. H. K. Schiedeck
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  2. F. Fischer
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  3. C. Gondeck
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  4. U. J. Roblick
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  5. H. P. Bruch
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Editors and Affiliations

  1. Abteilung für Allgemeine, Viszerale, Unfallchirurgie und Poliklinik, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler  & Jürgen Weitz  & 

  2. Chirurgie, Krankenhaus Gerresheim, Kliniken der Landeshauptstadt, Gräulinger Straße 120, 40625, Düsseldorf, Germany

    Bernward Ulrich

  3. The Pelican Cancer Foundation, North Hampshire Hospital, Basingstoke, Hampshire, RG24 9NA, UK

    Richard John Heald (OBE, Surgical Director) (OBE, Surgical Director)

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© 2005 Springer-Verlag Berlin Heidelberg

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Schiedeck, T.H.K., Fischer, F., Gondeck, C., Roblick, U.J., Bruch, H.P. (2005). Laparoscopic TME: Better Vision, Better Results?. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_16

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  • DOI: https://doi.org/10.1007/3-540-27449-9_16

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  • Print ISBN: 978-3-540-23341-1

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