Song Liang, MD, PhD, Morris E Franklin Jr, MD, FACS, Jeffrey L Glass, MD, FACS
Texas Endosurgery Institute
BACKGOUND AND OBJECTIVES: This prospective study focused on the patients with rectal cancer who underwent laparoscopic low anterior resection with total mesorectal excision and was specifically aimed at investigating if the this laparoscopic approach can be accepted as a safe and effective method for rectal malignancy.
METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal malignancy with various TMN classifications between April 1991 to May 2012 at the Texas Endosurgery Institute was analyzed, and all the statistical calculations were performed with SPSS.
RESULTS: A total of 469 patients underwent laparoscopic low anterior resection (LLAR) with total mesorectal excision (TME) with a conversion rate of 5.8% during this study period. Demographically the patients recruited into this study had the age of 65 (64.7 +/-13.1), and ASA of 2 (Median 2, range from 1-4). Moreover operating time for entire procedure was obtained to be 183.2 +/- 36.6 minutes, blood loss during the operations was estimated to 157.2 +/- 110 ml), and 16 procedures were complicated during the operation by various causes, thereby leading to intraoperative complication rate of 3.4%. Postoperatively the length for hospital stay was determined to be 8.3+/-5.1 days, and 32 various complications developed after the surgeries with the rate of 7.3%. Among all the postoperative complication, the anastomotic leak happened on 18 patients (4.1%). Lastly nearly 73% of the patients had been clinically followed for 2 years with 2-year local recurrence rate of 4.7% while 54% of the patients had for 10-year follow-up with preliminary result on 10-year recurrence , which shows leveling of stage III rectal cancer but improvement in outcome by 22 percent in the patients with stage II cancer.
CONCLUSIONS: Laparoscopic LAR with TME is a safe and effective approach with comparable postoperative complication rates and 5-year recurrence rate of cancer, thus it can be offered to selected patients by experienced laparoscopic colorectal surgeons.
Program Number: P013