Laparoscopic surgery of rectal cancer.: Oncological radicality and late results

The rectal cancer is one of the big challenges for laparoscopic surgery. From August 1993 to October 1999, at our hospital 108 rectal cancers including all UICC stages were laparoscopically operated on, 83 cases of them with curative intention. 77 % of the carcinomas were situated in the middle or lower rectal third. A rectal amputation was performed in 13 % of the cases, a continuity resection in 87 %. All valid histopathological quality criteria were fulfilled: en bloc resection, total mesorectal excision, distal tumor free resection edge, and truncal dissection of the lower mesenteric artery. 25 lymph nodes per specimen were histopathologically described on average. All preparations of curative operations were assessed as R0 resections. In a median follow up of 30 months we saw locoregional recurrences in 1.2 % and a recurrence-free survival in 90 %. In a subpopulation with 4 years follow up, the rate of local recurrences was 2 %, and the recurrence-free survival 85.7 %. The value of multimodal therapy concepts in total mesorectal excision cannot be assessed at present yet. Laparoscopic rectal surgery is a very effective treatment option for rectal cancer, but it should be practised only in specialized centres.