Total mesorectal excision (TME) with laparoscopic approach: 226 consecutive cases

Background: Total mesorectal excision (TME) of the rectum has been advocated as the gold surgical treatment of the middle and low third rectal cancer. Laparoscopy has gained acceptance among surgeons in the treatment of colon malignancies, while scepticism exists about laparoscopic THE in term of safety, and its oncological adequacy. Objective: To evaluate the impact of laparoscopic THE on surgical and oncological outcome in a group of consecutive unselected patients. Methods: 226 unselected patients with rectal cancer underwent laparoscopic THE from January 1998 to August 2007. Patients staged cT3/4 cTxN+ were submitted to neoadjuvant treatment. Postoperative complications and oncological outcome were registered. Results: Mean distance of the tumour from the anal verge was 6.2 +/- 2cm. 48.6% of patients were enrolled in "long-course" neoadjuvant chemo-radiotherapy (partial and complete response rates 72.4% and 20.1%, respectively). Surgical procedures were 202 anterior and 24 abdominal-perineal resections. Mean operative time 245.3 +/- 58.4min, mean blood loss 203 +/- 176mL. Conversion rate 6.1%. Thirty-days morbidity rate 31.8% without mortality. Anastomotic leaks rate was 16.8%. Reoperation rate 6.6%. Gastrointestinal recovery rate was 3.1 +/- 1.4 days and hospital stay 10.4 +/- 4.6 days. Concerning adequacy of oncologic resection, mean distance between tumour and margin of resection was 2.7 +/- 2cm with a nodal sampling of 14.4 +/- 4.6. Six patients (2.6%) had a R1 margin. With a mean follow-up of 39.8 months non port-site metastases occurred. Local recurrence rate was 6.1%. Five years cumulative overall survival was 81% and disease-free survival was 70% (Kaplan-Meier method). Conclusions: Laparoscopic approach for rectal tumour is a technically demanding procedure, but it is safe and it has the feature of an oncologic procedure. (c) 2007 Elsevier Ltd. All rights reserved.