Shigeki Yamaguchi, MD, Toshimasa Ishii, MD, Jo Tashiro, MD, Hiroka Kondo, MD, Kiyoka Hara, MD, Asami Suzuki, MD, Hiroki Shimuzu, MD, Ken-ichi Takemoto, MD, Shin-ichi Sakuramoto, MD, Kojun Okamoto, MD, Isamu Koyama, MD. Saitama Medical University International Medical Center
Purpose: From ALaCaLT and Z6054 trial, positive CRM of laparoscopic resection for rectal cancer was relatively higher than that of open resection. In this study, long term results of survival and local recurrence were assessed for laparoscopic lower rectal cancer resection.
Patients and method: Since April 2007 to February 2014, curative laparoscopic resection was performed for 264 lower (extraperitoneal) rectal cancer patients. Laparoscopic lateral lymphadenectomy was performed for 30 patients and 9 patients (3.4%) received preoperative chemoradiation. Statistical difference was decided by chi- square test.
Results: There were 181 males and 83 females, mean age 63.5 year old. Procedures were; LAR 56%, ISR 33%, APR 8%, Hartmann and TPC 3%. Pathological stage was; 0: 6, I: 101, II: 52, III: 105, and pathological CRM positive rate was 2.3% (6 pts). Mean observation was 40.2 months. Five year OS was; I: 95.1%, II: 87.1%, III: 79.3%, 3 year RFS was; I: 93.6%, II: 85.5%, III: 78.0%. Local recurrence was observed in 17 patients (6.4%) and no CRM positive patients in them. Local recurrence according to factors were; gender: male 4.4%, female 10.8% (p=0.048), Stage: I 5.0%, II 13.5%, III 4.8% (n.s.), lateral lymph node: positive 7.7%, negative 6.4% (n.s.), procedure: LAR 4.7%, ISR 10.5%, APR 4.5% (n.s.), surgeon: A 2.8% (4/145), B 7.7% (3/39), C 12.1% (7/58) (p=0.03, A vs C). Local recurrent sites were; anastomosis 5, lateral lymph node 6, intra-pelvic plexus 1, mobilized part 5 (levator 2, presacral 1, piriformis 1, recto-vaginal septum 1).
Conclusion: Although limited study of patient number and observation, rate of local recurrence was not increased after laparoscopic lower rectal cancer resection. Risk factors of local recurrence were female gender and surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79437
Program Number: P240
Presentation Session: Poster (Non CME)
Presentation Type: Poster
