• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Laparoscopic Total Mesorectal Excision for Middle and Low Rectal Adenocarcinoma with or Without Sphincter Preservation: A Prospective Study

Background: Reports on laparoscopic total mesorectum excision (TME) for cancer are often retrospective and contain heterogeneous patients who had several types of resection (i.e., anterior resection, low anterior resection, all or partially laparoscopic). The goal of this study was to assess the feasibility, safety, and effectiveness with respect to perioperative and oncological outcomes in two prospective series of all laparoscopic total mesorectal excision for rectum adenocarcinoma, one with, the other without anal sphincter preservation.

Patients and Methods:
Between November 2000 and July 2008, 104 unselected patients had laparoscopic TME for rectal adenocarcinoma. Patients with locally advanced rectal carcinoma (uN+/uT4) occasionally underwent preoperative radiation or chemoradiation. Postoperatively, adjuvant treatment was administered to patients with UICC stage II/III disease. All patients were followed up prospectively. Survival probability analysis was performed using the Kaplan-Meier method.

Results : There were 51 women and 52 men of a mean age of 58 years (range, 21-86). Conversion to laparotomy was necessary in 6 cases (5.7 %). Average operative time was 210 min (range, 120-550). One patient required blood transfusion (0.9 %). Intra-operative complications occurred in 5 patients (4.8 %) (2 left ureteral injuries, 2 splenic injuries, 1 vaginal tear, and 1 deferent duct section). There was one postoperative death (0.9 %). The most common postoperative complication was deep abscess in 9 patients (8.6 %) associated with anastomotic leakage in 7 patients (6.7 %) and with wound infection in 6 patients (5.7 %). Other complications included pneumonia (5 patients), urinary infection (5 patients), intestinal obstruction (2 patients), and miscellaneous (4 patients).
There were 71 sphincter-preserving procedures and 23 abdominoperineal resections. All but one resection margins were uninvolved. Among the former, 22 were performed for very low tumors, located within 4 cm of the dentate line. The average length of distal margins was 5.5 cm (range, 0-11). The mean number of harvested lymph nodes removed was 15 (range, 0-45) and mean length of the resected specimen was 28 cm (range, 20-101). Although resection was intended to be curative in all 84 patients, the distal margin (dentate line) was considered to be positive in one patient (0.9 %).
All patients were followed-up for an average of 62 months (range, 12-112). The most common late complications were incisional hernia in 8 patients (7.7 %) and intestinal obstruction in 4 patients (3.8 %). No port-site metastases occurred. Recurrence developed in 49 patients (47.1 %) including distant or peritoneal metastases (32 patients) and loco-regional recurrence (11 patients). Four patients had both local and distant metastases. Overall local recurrence rate was 10.6 %.

Conclusions: Laparoscopic total mesorectal excision for rectal cancer is a feasible and safe procedure. Oncological appropriateness is respected. However, large scale randomized studies are still needed in order to more accurately evaluate its efficacy and efficiency.


Session: Poster

Program Number: P131

View Poster

92

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons