Laparoscopic Anterior Resection for Rectal Cancer: an Analysis of Early Experiences

ABSTRACT

PURPOSE: Regarding laparoscopic colon cancer resection, the surgical society is currently waiting for the long-term oncologic result of multi-center randomized trials with over thousands patients. For rectal cancer surgery, however, laparoscopic approach is in much debate. The aim of this study was to evaluate the feasibility and safety of laparoscopic anterior resection for rectal cancer, based on the early results of our initial experiences. METHODS: Nineteen patients (MF=109, median age 55 years) underwent laparoscopic anterior resection for rectal cancer among the 71 malignant neoplasms of the colon and rectum resected laparoscopically between October 1997 and February 2001. All clinical data were prospectively collected. During the initial period, rectosigmoid lesion was the only indication. With the development of a new roticulating stapler for distal rectal transection, the indication was extended to the lesions of the upper and middle third of the rectum. The operation parameters (operation time, blood loss), tumor parameters (stage, resection margins, and number of resected lymph nodes), and postoperative clinical course (bowel function recovery, hospital stay, and complication) were evaluated. RESULTS: The tumors located in the rectosigmoid (n=13), upper third of the rectum (n=4), and the middle third of the rectum (n=2). Four cases were converted to an open procedure. The reasons for conversion were bladder invasion (1), tumor located too low (1), inappropriate distal resection margin (1), and tumor fixation to the sacrum (1). Median operation time was 210 minutes. Median blood loss was 400 ml. Median times to passage of flatus and oral feeding were 2 days and 3 days after surgery, respectively. Median length of the distal resection margin was 3 cm. Median number of harvested lymph nodes were 22. TNM stages were as follows; 0IIIIIIIV=12691. Two anastomotic leaks occurred in the converted patients. There were no major postoperative complications in other patients. There was no operative mortality. Median time to hospital discharge was 13 days. During a median follow-up period of 15 months, one patient developed distant metastases. There were no local/port sites recurrences. CONCLUSIONS: Laparoscopic anterior resection is a safe alternative to conventional surgery for rectal cancer. Long- term follow-up is mandatory to evaluate the oncologic safety.