Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases

Raffaele Pugliese, Stefano Di Lernia, Fabio Sansonna, Ildo Scandroglio, Dario Maggioni, Giovanni Carlo Ferrari, Andrea Costanzi, Carmelo Magistro, Stefano De Carli
American Journal of Surgery 2008, 195 (2): 233-8

BACKGROUND: Laparoscopic excision of rectal tumors has gained favor in the last decade and several issues have reported encouraging results: still, the use of laparoscopy remains open to debate. The aim of the current study is to assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer analyzing short-term outcomes and long-term survival.

METHODS: The charts of 157 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access. Patients undergoing emergency surgery were excluded. LAR was excluded in presence of preoperative features at computed tomography (CT) scan suggesting bulky tumors unresectable by laparoscopy or in case of anesthesiologic contraindications. Conversion rate and functional and oncologic outcomes were analyzed. Data on long-term results and survival were evaluated.

RESULTS: LAR was performed in 157 patients, and conversion to laparotomy was required in 12 cases. Mean operation time for nonconverted patients was 229 minutes (overall 238 minutes). Total mesorectal excision (TME) was performed in tumors of the mid and low rectum and a temporary ileostomy was performed in 56 patients. The mean length of hospital stay (LOS) was 10.5 days. Morbidity of anterior resection included 17 anastomotic leaks after laparoscopic surgery (LS; 5 in the converted patients). Conversion increased significantly the risk of leak (P < .005). Two leaks caused death. The mean number of nodes collected was 12. The incidence of local relapse was 4%, and the rate of anastomotic recurrence was nil. Survival probability with LS was .73 at 5 years. Patients in stage III took advantage of adjuvant treatment and had a better survival than patients in stage II (P = not significant [NS]).

CONCLUSIONS: The outcomes of this study suggest that LAR for rectal cancer is a reliable procedure. Oncologic requirements were respected; parameters such as length of specimen, distal margin, and number of nodes retrieved were quite acceptable. Incidences of local recurrence and long-term survival were comparable with those of other series.

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