Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI).

BACKGROUND: Right hemicolectomy is a very common surgery. Many studies compare different options for laparoscopic ileocolic anastomoses: intra- or extracorporeal; handsewn or stapled; side-to-side or end-to-side. However, there are no studies about the influence that peristalsis could have on this anastomosis. The aim of this study is to compare safety and feasibility of isoperistaltic and antiperistaltic anastomosis in terms of postoperative morbidity and mortality between both groups. The secondary endpoint is to compare long-term functional outcomes (chronic diarrhoea) and quality of life (GIQLI questionnaire) after a 1-year follow-up period. METHODS: A double-blind, randomised, prospective trial in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and isoperistaltic (ISO) or antiperistaltic (ANTI) ileocolic anastomoses. RESULTS: Hundred and eight patients were included in the study. Patients were randomised either to isoperistaltic or antiperistaltic configuration (54 ISO/ANTI). No significant differences in baseline variables were found. No differences in surgical time (130 [120-150] min ISO vs. 140 [127-160] ANTI, p = 0.481), nor in anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207) and nor in postoperative complications: 37.0% ISO versus 40.7% ANTI, (p = 0.693) were found. There were no differences in postoperative ileus (p = 0.112) nor in anastomotic leakage (3.7% vs. 5.56%, p = 1.00). Differences in "time to first flatus" and "time to first deposition" were found in favour of the antiperistaltic group (p = 0.004 and p = 0.017). Anastomotic configuration did not influence hospital stay (3 days [2-6] isoperistaltic vs. 3 [2-4] antiperistaltic, p = 0.236). During follow-up, there were no differences between the two groups at 1, 6 and 12 months (p = 0.154, p = 0.498 and p = 0.683), nor in chronic diarrhoea rates in GIQLI scores (24% ISO vs. 31.4% ANTI, p = 0.541). CONCLUSIONS: The isoperistaltic and antiperistaltic ileocolic anastomosis present similar results in terms of performance, safety and functionality. However, further studies must be carried out in order to assess relationship between postoperative ileus and anastomosis configuration. TRIAL REGISTRATION: Randomised Clinical trial (Identifier: NCT02309931).

Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico? / Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages?

Introducción: El abordaje laparoscópico en la cirugía por complicaciones colorrectales es controvertido. Sin embargo, puede proporcionar ventajas sobre la cirugía abierta. El objetivo del estudio es comparar el abordaje laparoscópico vs. el abordaje abierto en la reintervención por complicaciones tras cirugía colorrectal. Métodos: Se han analizado de forma retrospectiva, sobre una base de datos prospectiva, los pacientes intervenidos mediante cirugía laparoscópica colorrectal desde enero de 2006 a diciembre de 2015. Los pacientes que requirieron reintervenciones urgentes por complicaciones en el postoperatorio se dividieron según el abordaje (cirugía laparoscópica [CL] y cirugía abierta [CA]) y según su gravedad clínica (en función del índice de peritonitis de Mannheim [IPM]). Resultados: De 763 pacientes, 40 requirieron cirugía urgente (24 CA/16 CL). Se realizaron más ileostomías en el grupo CL (68,7% vs. 29,2%) y más colostomías en el grupo CA (37,5% vs. 6,2%), p<0,05. El IPM fue mayor en el grupo CA (27,31±6,47 [19-35] vs. 18,4±7,2 [11-24], p<0,001). La estancia hospitalaria tras la reintervención, tolerancia oral e infección de herida quirúrgica fueron favorables en CL (p<0,05). En pacientes con un IPM≤26, el abordaje laparoscópico mostró menor estancia hospitalaria, menor permanencia en unidad de críticos, tolerancia oral más temprana y menor infección de herida quirúrgica (p<0,05). Conclusiones: El abordaje laparoscópico en la reintervención por complicaciones tras cirugía colorrectal laparoscópica asocia una recuperación más rápida objetivada en un inicio precoz de tolerancia oral, menor estancia hospitalaria y menor tasa de hernia incisional en pacientes con bajo índice de gravedad (AU)

Introduction: The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. Methods: Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. Results: A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). Conclusions: A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index (AU)

Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages? / Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico?

INTRODUCTION: The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. METHODS: Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. RESULTS: A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). CONCLUSIONS: A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.

Torsión e infarto omental: una infrecuente complicación tardía del bypass gástrico / Omenal torsion and infarction: An unusual complication after Roux-en-Y Gastric Bypass

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El colgajo V-Y como método de reparación de defectos perianales extensos / V-Y advancement flaps for extensive perianal defect repair

INTRODUCCIÓN: Algunas enfermedades perianales precisan cirugías agresivas que crean la necesidad de recurrir a técnicas reparadoras para reconstruir la integridad de esta región. El objetivo de este estudio es analizar los resultados a corto y largo plazo tras reconstrucción perianal con colgajos V-Y. MÉTODO: Se ha revisado retrospectivamente nuestra base de datos institucional prospectiva (2000-2013), y se ha incluido en el presente análisis a todos los pacientes a los que se ha realizado una reconstrucción perianal con colgajo V-Y, tras escisión amplia perianal por enfermedad benigna o maligna. Se recogieron datos demográficos, quirúrgicos y la morbilidad a corto y largo plazo. RESULTADOS: Se analizó a un total de 10 pacientes, 6 varones y 4 mujeres, con edad media de 58,1 ± 17,4 años. El tiempo quirúrgico fue 143,5 ± 41,3 min y la estancia hospitalaria media tras la cirugía 7,8 ± 7,7 días. En 8 pacientes aparecieron complicaciones postoperatorias: dehiscencia parcial del colgajo (n = 6) y estenosis anal tardía (n = 4). En ningún caso se produjo la pérdida del colgajo. Siete pacientes presentaron buenos resultados en cuanto a la continencia anal, 2 pacientes incontinencia variable y en un caso se realizó una colostomía terminal por incontinencia grave. CONCLUSIÓN: Los colgajos V-Y son una técnica factible y efectiva para cubrir grandes defectos tras cirugías perianales agresivas; sin embargo, no están exentos de morbilidad postoperatoria

OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS: A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS: 10 patients were included, 6 males and 4 females. The average age was 58,1 ± 17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5 ± 41,3 min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8 ± 7,6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n = 4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS: V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity

V-Y advancement flaps for extensive perianal defect repair. / El colgajo V-Y como método de reparación de defectos perianales extensos.

OBJECTIVES: Some perianal pathologies require aggressive surgery that will need techniques to allow to re-establish the integrity of the perianal region. The purpose is to analyze short and long term results after perineal reconstruction with V-Y flaps. METHODS: A retrospective review of prospectively collected database was conducted at Virgen de la Arrixaca's Hospital in Murcia (España) between January 2000 and December 2013. The study includes all patients who underwent a perineal reconstruction with V-Y flaps. Demographic and surgical data and short-/long- term morbidity was recorded. RESULTS: 10 patients were included, 6 males and 4 females. The average age was 58,1±17,4 years. Surgical indication included both malignant and benign pathologies. Operating time was 143,5±41,3min. R0 resection was performed in all cases although histopathological analysis showed involvement of the deeper margin in 3 cases. Length of hospital stay was 7,8±7,6 days. Regarding complications: 6 patients had partial dehiscence of the flap. None of the patients lost the flap completely. The most frequent late complication was anal stenosis (n=4). Follow up showed total continence in 7 patients. Two patients had variable fecal and/or flatus incontinence. A colostomy was made in one case due to severe incontinence. CONCLUSIONS: V-Y flaps are an effective and feasible technique to cover large perianal defects after aggressive surgeries. However, this technique is not free of postoperative morbidity.

Tratamiento de la hemorragia presacra tras cirugía colorrectal mediante el uso del balón de Bakri / Treatment of presacral bleeding after colorectal surgery with Bakri balloon

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Utility of rectoscopy in the assessment of response to neoadjuvant treatment for locally advanced rectal cancer.

BACKGROUND/AIMS: The management of locally advanced rectal cancer has changed substantially over the last few decades with neoadjuvant chemoradiotherapy. The aim of the present study is to compare the results between neoadjuvant post-treatment rectoscopy and the anatomopathological findings of the surgical specimen. PATIENTS AND METHODS: We conducted a prospective study of 67 patients with locally advanced adenocarcinoma of the rectum (stages II and III). Two groups were established: One with complete clinical response (cCR) and one without (non-cCR), based on the findings at rectoscopy. Assessment of tumor regression grade in the surgical specimen was determined using Mandard's tumor regression scale. RESULTS: Seventeen patients showed a cCR. Thirty-five biopsies were negative and 32 were positive for malignancy. All the cCR patients had a negative biopsy (P < 0.0001). All 32 positive biopsies revealed the presence of adenocarcinoma, and of the 35 negative biopsies, 18 had no malignancy and 17 were diagnosed with adenocarcinoma (P < 0.0001). Sixteen of the 17 cCR patients showed a complete pathological response and one patient showed the presence of adenocarcinoma. Of the 50 non-cCR patients 48 revealed the presence of adenocarcinoma and two had absence of malignancy. According to the Mandard classification, 16 of the 17 cCR patients were grade I and 1 grade II; 2 non-cCR patients were grade I, 7 grade II, 13 grade III, 19 grade IV, and 9 grade V. CONCLUSIONS: Endoscopic and histological findings could be determinants in the assessment of response to neoadjuvant treatment.

Colectomía mediante puerto único vs colectomía mediante laparoscopia multipuerto. Revisión sistemática y metaanálisis de más de 2.800 procedimientos / Single-port colectomy vs multi-port laparoscopic colectomy. Systematic review and meta-analysis of more than 2800 procedures

OBJETIVOS: La cirugía laparoscópica multipuerto (CLM) ha demostrado su seguridad y efectividad en la cirugía del colon. Con la intención de reducir la agresividad surgen otras técnicas como la cirugía por puerto único (SILS). El objetivo de este metaanálisis es evaluar la seguridad y la viabilidad de la técnica SILS en la cirugía del colon. MATERIAL Y MÉTODOS: Se realiza un metaanálisis de 27 estudios observacionales y uno prospectivo aleatorizado mediante el modelo de efectos aleatorios. RESULTADOS: Se han analizado 2.870 procedimientos: 1.119 SILS y 1.751 CLM. No se han encontrado diferencias estadísticamente significativas en la edad (DMP 0,28 [−1,13, 1,68]; p = 0,70), IMC (DMP −0,63 [−1,34, 0,08]), ASA (DMP −0,02 [−0,08, 0,04]; p = 0,51), longitud de incisión (DMP −1,90 [−3,95, 0,14]; p = 0,07), tiempo operatorio (DMP −2,69 [−18,33, 12,95]; p = 0,74), complicaciones (OR = 0,89 [0,69, 1,15]]; p = 0,37), conversión a laparotomía (OR = 0,59 [0,33, 1,04]; p = 0,07), mortalidad (OR = 0,91 [0,36, 2,34]; p = 0,85) o número de ganglios obtenidos (DMP 0,13 [−2,52, 2,78]; p = 0,92). La pérdida de sangre (DMP −42,68 [−76,79, −8,57]; p = 0,01) y la estancia hospitalaria (DMP −0,73 [−1,18, −0,28]; p = 0,001) son significativamente menores en el grupo SILS. CONCLUSIONES: La cirugía colorrectal mediante SILS es segura y efectiva, con ligeros beneficios respecto a la CLM. Sin embargo, se necesitan más estudios aleatorizados antes de que la SILS se pueda considerar una alternativa a la CLM

OBJECTIVE: Multiport laparoscopic surgery in colon pathology has been demonstrated as a safe and effective technique. Interest in reducing aggressiveness has led to other procedures being described, such as SILS. The aim of this meta-analysis is to evaluate feasibility and security of SILS technique in colonic surgery. MATERIAL AND METHODS: A meta-analysis of twenty 7 observational studies and one prospective randomized trial has been conducted by the use of random-effects models. RESULTS: A total amount of 2870 procedures was analyzed: 1119 SILS and 1751 MLC. We did not find statistically significant differences between SILS and MLC in age (WMD 0.28 [−1.13, 1.68]; P=.70), BMI (WMD −0.63 [−1.34, 0.08]; P=.08), ASA score (WMD −0.02 [−0.08, 0.04]; P=.51), length of incision (WMD −1.90 [−3.95, 0.14]; P=.07), operating time (WMD −2.69 (−18.33, 12.95]; P=.74), complications (OR = 0.89 [0.69, 1.15]; P=.37), conversion to laparotomy (OR = 0.59 [0.33, 1.04]; P=.07), mortality (OR = 0.91 [0.36, 2.34]; P=.85) or number of lymph nodes harvested (WMD 0.13 [−2.52, 2.78]; P=.92). The blood loss was significantly lower in the SILS group (WMD −42.68 [−76.79, −8.57]; P=.01) and the length of hospital stay was also significantly lower in the SILS group (WMD −0.73 [−1.18, −0.28]; P=.001). CONCLUSION: Single-port laparoscopic colectomy is a safe and effective technique with additional subtle benefits compared to multiport laparoscopic colectomy. However, further prospective randomized studies are needed before single-port colectomy can be considered an alternative to multiport laparoscopic surgery of the colon

Tratamiento endoscópico con pegamento tisular biológico del seno presacro crónico tras resección anterior baja / Endoscopic treatment with biologic glue of chronic presacral sinus after low anterior resection

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Single-port Colectomy VS Multi-port Laparoscopic Colectomy. Systematic Review and Meta-analysis of More Than 2800 Procedures.

OBJECTIVE: Multiport laparoscopic surgery in colon pathology has been demonstrated as a safe and effective technique. Interest in reducing aggressiveness has led to other procedures being described, such as SILS. The aim of this meta-analysis is to evaluate feasibility and security of SILS technique in colonic surgery. MATERIAL AND METHODS: A meta-analysis of twenty 7 observational studies and one prospective randomized trial has been conducted by the use of random-effects models. RESULTS: A total amount of 2870 procedures was analyzed: 1119 SILS and 1751 MLC. We did not find statistically significant differences between SILS and MLC in age (WMD 0.28 [-1.13, 1.68]; P=.70), BMI (WMD -0.63 [-1.34, 0.08]; P=.08), ASA score (WMD -0.02 [-0.08, 0.04]; P=.51), length of incision (WMD -1.90 [-3.95, 0.14]; P=.07), operating time (WMD -2.69 (-18.33, 12.95]; P=.74), complications (OR=0.89 [0.69, 1.15]; P=.37), conversion to laparotomy (OR=0.59 [0.33, 1.04]; P=.07), mortality (OR=0.91 [0.36, 2.34]; P=.85) or number of lymph nodes harvested (WMD 0.13 [-2.52, 2.78]; P=.92). The blood loss was significantly lower in the SILS group (WMD -42.68 [-76.79, -8.57]; P=.01) and the length of hospital stay was also significantly lower in the SILS group (WMD -0.73 [-1.18, -0.28]; P=.001). CONCLUSION: Single-port laparoscopic colectomy is a safe and effective technique with additional subtle benefits compared to multiport laparoscopic colectomy. However, further prospective randomized studies are needed before single-port colectomy can be considered an alternative to multiport laparoscopic surgery of the colon.

The influence of the percentage of the common limb in weight loss and nutritional alterations after laparoscopic gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard for the treatment of morbid obesity. There is no consensus over ideal limb length when the bypass is created and published studies do not take into account the influence of the common limb (CL) on weight loss. The objective was to study the influence of the common limb after RYGB. The setting was the Virgen de la Arrixaca University Clinical Hospital in Murcia, Spain. MATERIAL AND METHODS: This prospective study includes 151 patients undergoing laparoscopic RYGB surgery for morbid obesity. The patients were divided into 2 groups according to their body mass index. The small intestine (SI) was measured using micro forceps so that the percentage of common limb (%CL) could then be compared against the total SI in each patient. The percentage of excess weight loss (%EWL) in relation to the %CL was calculated at 3, 12, and 24 months. A series of tests was conducted simultaneously to analyze nutritional deficiencies and their relation to the %CL. RESULTS: The total jejunoileal segment and the %CL in the groups of both obese and super-obese patients had no influence on the %EWL in either group for any of the periods studied. The patients with a %CL<50% had greater nutritional deficiencies in the follow-up period and required supplements and more frequent laboratory tests. CONCLUSIONS: The %CL has no effect on weight loss in RYGB patients. A lower %CL is related to greater nutritional deficiencies.

Tratamiento laparoscópico del linfoma de células B derivadas del tejido linfoide asociado a la mucosa de colon / Laparoscopic treatment of colon mucosa-associated lymphoid tissue lymphoma

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Aprendizaje de la cirugía del cáncer de recto por laparoscopia sin aumento de la morbimortalidad / The learning curve of laparoscopic treatment of rectal cancer does not increase morbidity

INTRODUCCIÓN: El tratamiento del cáncer de recto por laparoscopia es controvertido por su complejidad técnica. Estudios prospectivos aleatorizados han demostrado claras ventajas para el paciente, con resultados oncológicos equiparables a la cirugía abierta, aunque durante el aprendizaje de esta cirugía puede existir un aumento de las complicaciones y peor pronóstico. OBJETIVO: Nuestro objetivo es analizar cómo influye la curva de aprendizaje del cáncer de recto por vía laparoscópica en los resultados intra y postoperatorios, así como en los marcadores oncológicos. PACIENTES Y MÉTODOS: Se realizó una revisión retrospectiva de los 120 primeros pacientes intervenidos de neoplasia de recto por vía laparoscópica. La población a estudio se ordenó cronológicamente por fecha de intervención y se dividió en un primer grupo que contenía las 40 primeras intervenciones, y un segundo grupo que contenía las 80 siguientes. Las intervenciones fueron realizadas por el mismo equipo quirúrgico con una amplia experiencia en el tratamiento del cáncer colorrectal abierto, además de estar capacitados para realizar cirugía laparoscópica avanzada. Se analizaron sexo, ASA, localización del tumor, neoadyuvancia, técnica quirúrgica, tiempo operatorio, conversión, complicaciones postoperatorias, estancia hospitalaria, número de ganglios, estadio y afectación de márgenes. RESULTADOS: Se observaron diferencias significativas en cuanto a tiempo quirúrgico (224 min en el primer grupo, 204 min en el segundo grupo), con una mayor tasa de conversión en el primer grupo (22,5%) frente al segundo (11,3%). No se apreciaron diferencias significativas en cuanto a la tasa de cirugía conservadora de esfínteres, estancia hospitalaria, complicaciones posquirúrgicas, número de ganglios afectos/aislados ni márgenes circunferencial y distal afectos. CONCLUSIÓN: Es posible realizar el aprendizaje de esta compleja cirugía sin comprometer la seguridad y resultado oncológico del paciente

INTRODUCTION: The treatment of rectal cancer via laparoscopy is controversial due to its technical complexity. Several randomized prospective studies have demonstrated clear advantages for the patient with similar oncological results to those of open surgery, although during the learning of this surgical technique there may be an increase in complications and a worse prognosis. OBJECTIVE: Our aim is to analyze how the learning curve for rectal cancer via laparoscopy influences intra- and postoperative results and oncological markers. A retrospective review was conducted of the first 120 patients undergoing laparoscopic surgery for rectal neoplasia. The operations were performed by the same surgical team with a wide experience in the treatment of open colorectal cancer and qualified to perform advanced laparoscopic surgery. We analyzed sex, ASA, tumor location, neoadjuvant treatment, surgical technique, operating time, conversion, postoperative complications, length of hospital stay, number of lymph nodes, stage and involvement of margins. RESULTS: Significant differences were observed with regard to surgical time (224 min in the first group, 204 min in the second group), with a higher rate of conversion in the first group (22.5%) than in the second (11.3%). No significant differences were noted for rate of conservative sphincter surgery, length of hospital stay, post-surgical complications, number of affected/isolated lymph nodes or affected circumferential and distal margins. CONCLUSIONS: It is possible to learn this complex surgical technique without compromising the patient's safety and oncological outcome

The learning curve of laparoscopic treatment of rectal cancer does not increase morbidity.

INTRODUCTION: The treatment of rectal cancer via laparoscopy is controversial due to its technical complexity. Several randomized prospective studies have demonstrated clear advantages for the patient with similar oncological results to those of open surgery, although during the learning of this surgical technique there may be an increase in complications and a worse prognosis. OBJECTIVE: Our aim is to analyze how the learning curve for rectal cancer via laparoscopy influences intra- and postoperative results and oncological markers. A retrospective review was conducted of the first 120 patients undergoing laparoscopic surgery for rectal neoplasia. The operations were performed by the same surgical team with a wide experience in the treatment of open colorectal cancer and qualified to perform advanced laparoscopic surgery. We analyzed sex, ASA, tumour location, neoadjuvant treatment, surgical technique, operating time, conversion, postoperative complications, length of hospital stay, number of lymph nodes, stage and involvement of margins. RESULTS: Significant differences were observed with regard to surgical time (224 min in the first group, 204 min in the second group), with a higher rate of conversion in the first group (22.5%) than in the second (11.3%). No significant differences were noted for rate of conservative sphincter surgery, length of hospital stay, post-surgical complications, number of affected/isolated lymph nodes or affected circumferential and distal margins. CONCLUSIONS: It is possible to learn this complex surgical technique without compromising the patient's safety and oncological outcome.