Laparoscopic Surgery After Preoperative Chemoradiation for Advanced Lower Rectal Cancer

Shinya Morimoto, MD, Mitsuo Shimada, MD PhD, Nobuhiro Kurita, MD PhD, Hirohiko Sato, MD, Takashi Iwata, MD, Masanori Nishioka, MD, Tomohiko Miyatani, MD, Kozo Yoshikawa, MD, Masakazu Goto, Dr, Hideya Kashihara, Dr, Chie Mikami, Dr. University of Tokushima

[INTRODUCTION] Laparoscopic surgery for advanced colon cancer has been widely accepted. A few studies have shown that there are advantages of laparoscopic over open TME surgery for rectal cancer. However, the feasibility of laparoscopic surgery for T3 and T4 rectal cancer has not been clearly defined specifically in cases following preoperative CRT.
Preoperative chemoradiation therapy (CRT) for low rectal cancer reduces local recurrence and increases anal sphincter preservation rate.[Purpose] The aim of this study was to investigate the feasibility of laparoscopic surgery and the results of anorectal function after preoperative CRT for advanced lower rectal cancer.[METHODS AND PROCEDURES] Between May 2003 and May 2011, 67 patients who underwent preoperative CRT for lower rectal cancer were identified. Fifty-three patients with laparoscopic surgery (Lap group) were compared with 14 patients with open surgery (Open group). Wexner scores and stool frequency were checked at six months, one year, two years and three years after closure of ileac stoma on 19 patients.[Results] All patients underwent complete laparoscopic operations and none were converted to laparotomy. 5 year over all survival rate was 77% in CTR. 5 year disease free survival rate was 60%.Local recurrence rate was 7%, metastatic recurrence rate was 24%. Operating time was longer in the Open group (331 versus 375 min, p<0.01). Blood loss during the operation decreased in the Lap group (160 versus 316 min, p<0.01). Lymph node harvest (10 versus 11) and morbility rate (21 versus 29) were similar in both groups. No patients had peri-operative mortality associated with surgery after CRT. Postoperative hospital stay was shorter in the Lap group (28 versus 38 days, p<0.01).
The mean Wexner scores were 8 (six months after operation), 6 (one year), 2 (two years) and 3 (three years). The mean stool frequency were 10 times per day (six months after operation), 6 (one year), 5 (two years) and 4 (three years). Wexner scores and stool frequency significantly improved at each time after operation.[Conclusion] Laparoscopic surgery after preoperative CRT is a feasible and a safer option for advanced lower rectal cancer compared to conventional open surgery.
 

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