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. 2003 Mar;237(3):335-42.
doi: 10.1097/01.SLA.0000055270.48242.D2.

Laparoscopic total mesorectal excision: a consecutive series of 100 patients

Mario Morino  1 , Umberto Parini, Giuseppe Giraudo, Micky Salval, Riccardo Brachet Contul, Corrado Garrone
Affiliations

Laparoscopic total mesorectal excision: a consecutive series of 100 patients

Mario Morino et al. Ann Surg. 2003 Mar.

Abstract

Objective: To analyze total mesorectal excision (TME) for rectal cancer by the laparoscopic approach during a prospective nonrandomized trial.

Summary background data: Improved local control and survival rates in the treatment of rectal cancer have been reported after TME.

Methods: The authors conducted a prospective consecutive series of 100 laparoscopic TMEs for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncologic results were reviewed.

Results: The distal limit of rectal neoplasm was on average 6.1 (range 3-12) cm from the anal verge. The mean operative time was 250 (range 110-540) minutes. The conversion rate was 12%. Excluding the patient who stayed 104 days after a severe fistula and reoperation, the mean postoperative stay was 12.05 (range 5-53) days. The 30-day mortality was 2% and the overall postoperative morbidity was 36%, including 17 anastomotic leaks. Of 87 malignant cases, 70 (80.4%) had a minimum follow-up of 12 months, with a median follow-up of 45.7 (range 12-72) months. During this period 18.5% (13/70) died of cancer and 8.5% (6/70) are alive with metastatic disease. The port-site metastasis rate was 1.4% (1/70): a rectal cancer stage IV presented with a parietal recurrence at 17 months after surgery. The locoregional pelvic recurrence rate was 4.2% (3/70): three rectal cancers stage III at 19, 13, and 7 postoperative months.

Conclusions: Laparoscopic TME is a feasible but technically demanding procedure (12% conversion rate). This series confirms the safety of the procedure, while oncologic results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.

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Figures

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Figure 1. Trocar positions for laparoscopic total mesorectal excision; dotted lines represent possible sites of minilaparotomy. The numbers represent the size of trocars (5 or 10 mm).
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Figure 2. Laparoscopic view at the end of total mesorectal excision before division of the rectum.
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Figure 3. Laparoscopic-assisted end-to-end colorectal anastomosis with a double-stapled technique.
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Figure 4. Survival rate by stage evaluated using Kaplan-Meier statistical analysis. Time represented in postoperative months.
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Figure 5. Disease-free rate by stage evaluated using Kaplan-Meier statistical analysis. Time represented in postoperative months.
See this image and copyright information in PMC

References

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