title: Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial.
abstract: OBJECTIVE
  The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation.
  
  
  METHODS
  Twenty eight patients with distal rectal adenocarcinoma were randomized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospectively. Thirteen underwent laparoscopic abdominoperineal resection and 15 conventional approach.
  
  
  RESULTS
  There was no significant difference (p<0,05) between the two studied groups regarding: gender, age, body mass index, patients with previous abdominal surgeries, intra and post operative complications, need for blood transfusion, hospital stay after surgery, length of resected segment and pathological staging. Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach (p=0.04). Mean anesthesia duration was shorter (p=0.03) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes, respectively. There was no need for conversion to open approach in this series. After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery, local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group.
  
  
  CONCLUSIONS
  We conclude that laparoscopic abdominoperineal resection is feasible, similar to conventional approach concerning surgery duration, intra operative morbidity, blood requirements and post operative morbidity. Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer.
authors.affiliation: Digestive Surgery Department, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
authors.forename: Afonso Henrique
authors.initials: AH
authors.lastname: da Silva eSousa
authors.forename: Fábio Guilherme Caserta Marysael
authors.initials: FG
authors.lastname: de Campos
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Rodrigo Blanco
authors.initials: RB
authors.lastname: Dumarco
authors.forename: Pedro Paulo de Paris
authors.initials: PP
authors.lastname: Caravatto
authors.forename: Sergio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: JoséHyppólito
authors.initials: J
authors.lastname: da Silva
authors.forename: Desidério Roberto
authors.initials: DR
authors.lastname: Kiss
authors.forename: Joaquim José
authors.initials: JJ
authors.lastname: Gama-Rodrigues
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy