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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


Mr D. G. Glancy, MD, FRCS, Department of Colorectal Surgery, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, UK.


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.