Laparoscopic resection for rectal carcinoma -: State of the art

One of the most controversial areas of laparoscopic colorectal surgery is that of rectal cancer. This is due to the fact that most reported data on laparoscopic rectum resection are characterized by small series of patients and must be considered to give preliminary or medium-term results at best. The purpose of this study is to report our own experience and to review articles dealing with laparoscopic rectum resection for cancer. Between November 1992 and July 2003, a total of 194 patients were resected laparoscopically for rectal carcinoma at our department. All patients were followed up prospectively in order to evaluate complications and late outcomes. The survival probability analysis was performed by using the Kaplan-Meier method. Study selection was made by MEDLINE. Single case reports and abstracts were excluded. The most common procedure was low anterior resection with total mesorectum excision in 65.5% of the patients. Average operative time was 174 min. Average number of lymph nodes removed was 25.4 and average length of specimens resected was 27.6 cm. UICC tumor stages were as follows: stage I 25.2%, stage II 27.3%, stage III 30.4%, and stage IV 17%. A conversion to conventional surgery was necessary in 2 cases. The most common postoperative complication was anastomotic leakage in 11.8% of the patients. There was no postoperative mortality. Follow-up evaluation ranged from 12 to 128 months, with a mean of 46.1 months. The most common late complication was incisional hernia in 3.6% of the patients. Port site metastases occurred in 1 patient ( 0.5%). Local recurrence rate was 4.1% after curative resection. Overall 5-year survival rate was 76.9% after curative resection and 31.8% after palliative resection. Cancer-related 5-year survival rate was 87.7% after curative resection and 48.5% after palliative resection. At 5 years, the survival rate was 100% for stage I, 94.4% for stage II, 66.6% for stage III, and 44.6% for stage IV. Our results and the literature review clearly demonstrate the fundamental feasibility and efficacy of laparoscopic resection for rectal cancer. This technique is not associated with a higher morbidity and mortality. Established oncological and surgical principles are respected and long-term outcomes are at least equal to open surgery.