Laparoscopic Low Anterior Resection with Total Mesorectal Excision, 17 Years Experience with 590 Patients

Introduction
Laparoscopic surgery has been established as the procedure of choice for much intra-abdominal disease process. However laparoscopic colon surgery has been the focus of much criticism and debate, while surgical procedure per se has gained acceptance, the indications for surgery has been the center of controversy, primarily regarding the safety and efficacy of these minimally invasive procedures for the treatment of colorectal malignancy. We present data collected prospectively from a single institution over a seventenn-year period, on laparoscopic low anterior resection with total mesorectal Excision for rectal Cancer.
Method
All patients undergoing totally laparoscopic or laparoscopically assisted low anterior resection (LAR) with Total Mesorectal Excision from Feb 1991 to May 2008 at Texas Endosurgery Institute, San Antonio, Texas were included in the study. Data was collected on pre-operative work-up, operative time, blood loss, pathologic details of the surgical specimen, and post-operative course.

Follow up was done through office charts and direct patient contact.
Results
A total of 590 patients underwent laparoscopic Low anterior resection with total Mesorectal Excision. 324 patients have malignant disease (55%) and 266 patients had benignant disease (45%). Eighty six % of the patients received totally laparoscopic LAR and 14% laparoscopically assisted LAR.
Five hundred and forty two (92%) patients were elective and 8% had an emergency procedure. Thirty patients required conversion to open procedure (5%). The mean operating time was 150 minutes (range 120-405, median 196 minutes). Mean and median blood loss was 100 ml (range 25-600 ml). The average number of lymph nodes harvested was 15 with a median of 17 lymph nodes. Median post-operative hospital stay was 6 days (range 4-18 days). Anastomotic leak rate was 1.2%. Local recurrence rate was 2.6% and the 5 years survival rate was 81%. There were no recurrences at wound or trocar sites.
Conclusion
Laparoscopic low anterior resection with total mesorectal excision is safe, feasible and effective.
Laparoscopic TME is associated with good long term oncological outcomes.
The laparoscopic approach should be considered an excellent option for both benignant
and malignant disease.


Session: Podium Presentation

Program Number: S001

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