title: Laparoscopic total mesorectal excision: a consecutive series of 100 patients.
abstract: OBJECTIVE
  To analyze total mesorectal excision (TME) for rectal cancer by the laparoscopic approach during a prospective nonrandomized trial.
  
  
  BACKGROUND
  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.
authors.affiliation: Second Department of Surgery, University of Turin, Turin, Italy. mario.morino@unito.it
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.forename: Umberto
authors.initials: U
authors.lastname: Parini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giraudo
authors.forename: Micky
authors.initials: M
authors.lastname: Salval
authors.forename: Riccardo
authors.initials: R
authors.lastname: Brachet Contul
authors.forename: Corrado
authors.initials: C
authors.lastname: Garrone
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D000236:Adenoma / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D015996:Survival Rate