Laparoscopic Surgery for advanced rectal cancer

Background: The laparoscopic approach is accepted as an alternative to open surgery for colon cancer. However, it has not been determined whether laparoscopy can be used in the setting of rectal cancer. Moreover laparoscopic surgery for advanced rectal cancer demands technical experience and needs longer learning time. This study evaluated the peri-operative clinical outcomes and short-term oncological outcomes of laparoscopic surgery for advanced rectal cancer.
Methods: Retrospective review of patients with rectal cancer treated using laparoscopy from August 2004 to August 2007. Peri-operative outcomes and short-term oncological outcomes were compared between low T stage rectal cancer(Tis,T1,T2) and high T stage rectal cancer(T3, T4).
Results: Total 128 patients underwent laparoscopic surgery for rectal cancer. 37 cases were low T rectal cancer, and 91 cases were high T rectal cancer. Sphincter saving procedure was performed in 35 cases in low T group(94.6%) and 80 cases in high T group(87.9%). Stage 0 was 8 cases(21.6%), stage I was 23 cases(62.2%), stage III was 6 cases(16.2%) in low T group. Stage II was 34 cases(37.4%), stage III was 48 cases(52.7%), and stage IV was 9 cases(9.9%) in high T group. R0 resection was performed in 100% in low T group, and 90.1% in high T group. Neoadjuvant chemoradiation was performed in 4 cases(10.8%) in low T group, and 17 cases(18.9%) in high T group. There were no statistical differences between two groups in terms of age, BMI, distance from anal verge, operating time, blood loss, distal margin, proximal margin, day of pass flatus, diet start, and hospital stay. Tumor size was 3.3?.8cm in low T group, and 5.1?.0cm in high T group(P=0.000). Radial margin was 1.8?.7cm in low T group, and 0.8?.5cm in high T group(P=0.000). Number of lymph node was 14.5?.3 in low T group, and 18.8?.6 in high T group(P=0.012). There was no conversion in low T group, and 4 cases were converted to open surgery in high T group. With mean follow up of 18 months(1-38 months), recurrence rate in high T group was 6% and o% in low T group.
Conclusions: The results of this study show high T stage rectal cancer had acceptable peri-operative outcomes and short-term oncological outcomes compare to the low T stage rectal cancer. However, further investigations of laparoscopic surgery for advanced rectal cancer are needed to establish the long-tern oncological safety of laparoscopic surgery for advanced rectal cancer.


Session: Poster

Program Number: P097

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