Abstract
Introduction
Total mesorectal excision (TME) with preoperative chemoradiation therapy is an accepted standard treatment for low rectal cancer. Although the laparoscopic approach is accepted for the treatment of colon cancer, its value for low rectal cancer is unknown. The purpose of this study was to evaluate whether preoperative chemoradiation therapy exerted an adverse influence on laparoscopic TME for low rectal cancer.
Methods
We studied 125 consecutive patients who underwent laparoscopic TME for low rectal cancer. Twenty patients with preoperative chemoradiation therapy (CRT-Lap group) were compared with 105 patients without chemoradiation therapy (non-CRT-Lap group).
Results
Operating time in the CRT-Lap group (276 min, range 160–390 min) was no different from that in the non-CRT-Lap group (263 min, range 143–456 min). The CRT-Lap group had more blood loss during the operation (70 vs. 37 ml), but mean blood loss was <100 ml. The distal tumor margin was longer in the CRT-Lap group (25.8 vs. 18.6 mm). The number of lymph node harvested did not differ between the groups (14.5 vs. 15.4). Conversion to open surgery was necessary only in one case in the non-CRT-Lap group. There was no anastomotic leakage in the CRT-Lap group, whereas three patients (3.1%) had anastomotic leakage in the non-CRT-Lap group.
Conclusion
Laparoscopic TME with preoperative chemoradiation therapy is a safe procedure with reasonable operating time and does not appear to pose any threat to the surgical and oncologic outcomes.
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References
Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059. doi:10.1056/NEJMoa032651.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718–1726. doi:10.1016/S0140-6736(05)66545-2.
Tjandra JJ, Chan MK, Yeh CH. Laparoscopic- vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 2008;51:26–31. doi:10.1007/s10350-007-9107-1.
Barlehner E, Benhidjeb T, Anders S, Schicke B. Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 2005;19:757–766. doi:10.1007/s00464-004-9134-0.
Palanivelu C, Sendhilkumar K, Jani K, Rajan PS, Maheshkumar GS, Shetty R, Parthasarthi R. Laparoscopic anterior resection and total mesorectal excision for rectal cancer: a prospective nonrandomized study. Int J Colorectal Dis 2007;22:367–372. doi:10.1007/s00384-006-0165-y.
Tsang WW, Chung CC, Kwok SY, Li MK. Laparoscopic sphincter-preserving total mesorectal excision with colonic J-pouch reconstruction: five-year results. Ann Surg 2006;243:353–358. doi:10.1097/01.sla.0000202180.16723.03.
Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, Darzi AW, Heriot AG. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol 2006;13:413–424. doi:10.1245/ASO.2006.05.045.
Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003;237:335–342. doi:10.1097/00000658-200303000-00006.
Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, Marescaux J. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004;18:281–289. doi:10.1007/s00464-002-8877-8.
MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457–460. doi:10.1016/0140-6736(93)90207-W.
Han N, Galandiuk S. Induction chemoradiation for rectal cancer. Arch Surg 2006;141:1246–1252. doi:10.1001/archsurg.141.12.1246.
Kuo LJ, Liu MC, Jian JJ, Horng CF, Cheng TI, Chen CM, Fang WT, Chung YL. Is final TNM staging a predictor for survival in locally advanced rectal cancer after preoperative chemoradiation therapy? Ann Surg Oncol 2007;14:2766–2772. doi:10.1245/s10434-006-9217-3.
Shivnani AT, Small W Jr, Stryker SJ, Kiel KD, Lim S, Halverson AL, Talamonti MS. Preoperative chemoradiation for rectal cancer: results of multimodality management and analysis of prognostic factors. Am J Surg 2007;193:389–393. doi:10.1016/j.amjsurg.2006.09.030.
Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006;244:758–763. doi:10.1097/01.sla.0000219017.78611.49.
Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, Kranenbarg EK, Leer JW. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002;20:817–825. doi:10.1200/JCO.20.3.817.
Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SH. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 1999;230:544–552. doi:10.1097/00000658-199910000-00010.
Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T. Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 2008;22:557–561. doi:10.1007/s00464-007-9626-9.
Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 2004;240:260–268. doi:10.1097/01.sla.0000133185.23514.32.
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Akiyoshi, T., Kuroyanagi, H., Oya, M. et al. Safety of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer with Preoperative Chemoradiation Therapy. J Gastrointest Surg 13, 521–525 (2009). https://doi.org/10.1007/s11605-008-0744-z
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DOI: https://doi.org/10.1007/s11605-008-0744-z