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Laparoscopic total mesorectal excision can be performed on a nonselective basis in patients with rectal cancer with excellent medium-term results

Authors


Mr D. G. Glancy, MD, FRCS, Department of Colorectal Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, UK.
E-mail: damian@glancys.fsworld.co.uk

Abstract

Aim  Concerns exist regarding laparoscopic rectal cancer surgery due to increased rates of open conversion, complications and circumferential resection margin positivity. This study reports medium-term results from consecutive unselected cases in a single surgeon series.

Method  The results of laparoscopic total mesorectal excision (TME) for rectal cancer over a 9-year period within the context of an evolving ‘enhanced recovery protocol’ (ERP) were reviewed from analysis of a prospectively maintained database.

Results  One hundred and fifty patients (91 male, median age 69 years, median BMI 26) underwent laparoscopic TME over 9 years. Median follow up was 28.5 months (range 0–88). Sixteen (10.6%) patients underwent neoadjuvant radiotherapy. Six (4.0%) required open conversion and 13 (9.0%) had an anastomotic leakage. The proportion of Dukes stages were: A, 33.3%; B, 30.7%; C, 31.3%; D, 4.7%. Five (3.3%) patients had an R1 and one an R2 resection. Median length of postoperative stay was 6 days. Three (2.0%) patients died within 30 days. Four (2.7%) developed local recurrence and 14 (9.3%) developed distant metastases. Predicted 5-year disease-free and overall survival rates by Kaplan–Meier analysis were 85.8% and 78.7%, respectively.

Conclusion  Laparoscopic TME surgery can safely be offered to unselected patients with rectal cancer with excellent medium-term results.

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