Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer
Article first published online: 15 AUG 2003
Volume 5, Issue 5, pages 451–453, September 2003
How to Cite
Bretagnol, F., Rullier, E., Couderc, P., Rullier, A. and Saric, J. (2003), Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Disease, 5: 451–453. doi: 10.1046/j.1463-1318.2003.00521.x
- Issue published online: 15 AUG 2003
- Article first published online: 15 AUG 2003
- Received 3 October 2002; accepted 1 December 2002
- total mesorectal excision;
- rectal cancer;
- coloanal anastomosis;
- intersphincteric resection
Aim The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic total mesorectal excision (TME) with coloanal anastomosis for mid and low rectal cancer.
Methods During a 2-year period, 50 patients underwent laparoscopic TME with coloanal anastomosis for rectal carcinoma located at a median of 4.5 (range 2–11) cm from the anal verge. Pre-operative radiotherapy was used in 46 patients. Intersphincteric dissection was combined with the laparoscopic procedure to achieve sphincter preservation.
Results Conversion to a laparotomy was necessary in six patients. Postoperative mortality and morbidity were 2% and 28%, respectively. Morbidity was lower in patients operated on during the second part of the study, who had extraction of the rectal specimen through a small laparotomy incision, than in those operated on during the first part of the study when removal of the specimen was by transanal extraction. Oncological quality of excision was safe in 44 patients with intact or almost intact rectal fascia in 88% and R0 resection in 90%. At a median follow-up of 18 months, there was no local or port-site recurrence.
Conclusion This study confirms our preliminary results of oncological feasibility of laparoscopic TME with sphincter preservation for mid and low rectal cancer, and showed that morbidity can be decreased by using a standardized surgical procedure.