Outcomes in 132 patients following laparoscopic total mesorectal excision (TME) for rectal cancer with greater than 5-year follow-up

John H Marks, Renee Huang, Dominique McKeever, Morgan Greenfield
Surgical Endoscopy 2016, 30 (1): 307-14

INTRODUCTION: The role of laparoscopic TME for rectal cancer is still questioned as a safe and adequate cancer operation. Currently, multicenter randomized prospective trials are underway to evaluate this. We analyze our long-term results using laparoscopic TME in the treatment of rectal cancer to evaluate its oncologic outcomes.

METHODS: A prospective laparoscopic database was queried to identify all patients operated upon for rectal cancer from April 1997 to September 2007. In total, 151 patients were identified. Metastatic disease excluded 19 patients, leaving 132 patients to be analyzed for perioperative and 5-year oncologic outcomes. Procedures included LAR, n = 35; transanal abdominal transanal proctosigmoidectomy, n = 77; and APR, n = 20. All surgeries were TME or pTME.

RESULTS: Laparoscopic TME was performed on 89 men (67%), mean age 61 (22-85). Preoperative chemoradiation was administered in 119 (90.2 %) with median dose of 5500 cGy (3800-10,080). Mean EBL was 300 ml, and 4.5% were transfused. Seven patients (5.3%) underwent conversion, 5 to lap-assisted, with a 1.5% conversion rate to open. Pathologic stage of disease: complete response: 24%; I: 36%; II: 22%; III: 18%. There were no mortalities. Overall morbidity was 23.5%, with no anastomotic leaks and 5 (3.8%) delayed anastomotic stricture/fistula. There were no port site recurrences. Mean follow-up was 69.4 months (7.6-168.0). Overall LR was 5.3% (n = 7). There was only one isolated LR (0.8%). Mean time to local recurrence was 13.9 months. Metastatic rate was 18.2%. By stage, disease-specific survival was: CR 86.3%; I: 87.4%; II: 86.4%; III: 77.4%. Overall, 5-year survival was 84.8%.

CONCLUSION: The long-term data confirm that laparoscopic TME can be performed with lasting low local recurrence (5.3 %) and excellent 5-year survival (84.8%). This report's importance stems from it representing one of the largest experiences of rectal cancer treated by laparoscopic TME with greater than 5-year follow-up reported in the literature.

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