Laparoscopic Assisted Surgery for Rectal Cancer. Our Experience and Results in 430 Cases.

Introduction: Laparoscopic assisted surgery for rectal cancer is still a challenge for surgeons. Actually colorectal surgeons believe that total mesorectal excision provides favorable oncologic results for the treatment of rectal cancer and more and more believe that laparoscopic approach is a good and safe approach to do it. The present study is a feasibility study that sows that total mesorectal excision can be safely performed by laparoscopic approach with good results.

Objective: The objective of this paper is to asses the results of rectal cancer patients treated by laparoscopic techniques.

Methods: From March 1998 to July 2007 all patients with an adenocarcinoma of the rectum admitted to our unit were evaluated to be operated by laparoscopic approach.

Results: Four hundred and thirty patients (272 male and 158 female) were included with a mean age of 66.83 years. Surgical technique was: 226 low anterior resections with total mesorrectal excision, 75 abdomino-perineal, 86 anterior resections, 30 Hartmann´s procedure, 11 colostomy and 2 proctocolectomy. Protective loop ileostomy was performed in 144 patients (45.85% of patients with sphincter preservation). Conversion to open approach rate was 13.48% (28 because of difficult dissection, 23 adjacent organs infiltration, 2 bleeding , 3 hipercarbia and two uretheral section). 34 patients presented anastomotic leakages (10,82% of resections with anastomosis). Mean hospital stay was 7 days and the starting of the oral intake was 48 hours. The mean of lymph nodes was 13.3. In this group of patients we made a learning curve study comparing the first 50 cases and last 50 with better results in the second group in terms of surgical time, extent of resection and conversion rate.

Conclusion: Laparoscopic surgery in patients with adenocarcinoma of the rectum can be safely performed. Short term results are good and large term results are similar than conventional tecniques and as long as we get into the learning curve we get shorter hospital stay and less conversion rate.

Session: Podium Presentation

Program Number: S101

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