Laparoscopic total mesorectal excision for rectal cancer - the way to minimise local recurrence?: P101

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Aim:Concerns exist regarding laparoscopic rectal cancer surgery due to increased rates of open conversion/complications and circumferential resection margin positivity (a surrogate for local recurrence). This study reports results from a single-surgeon series.Method:Prospective data were collected for all patients undergoing laparoscopic total mesorectal excision (TME) for rectal cancer. Records were updated at each outpatient follow-up. No patients with advanced disease or unfavourable histology were excluded.Results:One hundred and fifty patients (91 males, mean age 65.9 years and median BMI 26) underwent laparoscopic TME over 10 years. Mean length of follow-up was 144.8 weeks. Sixteen patients (10.6%) underwent neoadjuvant radiotherapy. Six patients (4.0%) required open conversion and nine patients (6.3%) developed anastomotic leakage. Duke's stage: A (50 patients), B (46), C (47), D (7). Five patients (3.3%) had an R1 resection with one R2. Median length of post-operative stay was 6.0 days. Three patients (2.1%) died within 30 days. Median time to first post-operative oncology appointment was 3.9 weeks. Four patients (2.7%) developed local recurrence.Conclusion:A non-selective approach to laparoscopic surgery for rectal cancer can result in excellent short and long-term outcomes. The low rate of local recurrence may reflect an attenuated immunological surgical stress response and early oncology follow-up.

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