Objective: To investigate the feasibility of laparoscopic total mesorectal excision (TME) in mid-lower rectal cancers following neoadjuvant chemoradiation (nCRT).
Summary Background data: The laparoscopic approach for 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 role of laparoscopy has not been clearly defined specifically in cases following nCRT.
Methods: All patients with rectal cancer who underwent nCRT were identified; no operations for rectal carcinoma were performed laparoscopically prior to 2005. The laparoscopic cases were matched to open cases based on gender, procedure, age and BMI. The medical records were reviewed and short term outcome was compared between these two groups. Statistical analysis was performed using SPSS© 15 software.
Results: Between 2002 and 2008, 64 patients were identified; including 32 laparoscopic cases and 32 open cases. There was no difference between the two groups based on gender, procedure, age, BMI, or ASA classification. The procedures performed within each group included 8 abdominoperineal resections and 24 anterior resections, which included 20 colonic J-pouch-anal anastomoses and 4 straight coloanal anastomoses. In the laparoscopic group, 12 received totally laparoscopic operations, 12 were either laparoscopic-assisted or hand-assisted procedures, and 8 were converted. The reasons for conversion included bleeding, splenic injury, and difficult anatomy. There was no difference in comorbidities, tumor location, tumor size, tumor stage,or radiation dose between the two groups. Operative time was longer in the laparoscopic group(205±49 vs 267±76 minutes, p
Program Number: P171