Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients.
BACKGROUND
This study aimed to prospectively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon.


METHODS
Three hundreds twelve patients (male, 181) were enrolled in this analysis. 257 patients (82.4%) had tumors located below 12 cm from the anal verge. Distribution of TNM stages was 0:I:II:III:IV = 4.2%:17.9%:32.4%:37.2%:8.3%. 225 patients (71.1%) had T3/T4 lesions. Pre- and post-operative radiation was given in 6 and 20 patients, respectively.


RESULTS
Sphincter-preserving operation was performed in 85.9%. Mean operating time was 212 minutes. Conversion rate was 2.6%. Overall morbidity rate was 21.1%. Anastomotic leakage occurred in 6.4%. Operative mortality rate was 0.3%. Mean number of harvested nodes was 23. Mean distal tumor-free margin was 2.8 cm. The circumferential resection margin was positive in 13 patients (4.2%). With a mean follow-up of 30 months in the stage I-III patients, the local recurrence rate was 2.9%. Systemic recurrence occurred in 11.7%. No port-site recurrence was observed.


CONCLUSIONS
Laparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes. When considering a high volume of advanced and low-lying cancers but rather narrow indication to radiotherapy, the 2.9% local recurrence rate seems promising data. Long-term follow-up is mandatory to draw conclusion.
Kim
Seon-Hahn
SH
Colorectal Division, Department of Surgery, Digestive Disease Center, DongGuk University Hospital, Goyang. drkimsh@chollian.net
Park
In-Ja
IJ
Joh
Yong-Geul
YG
Hahn
Koo-Yong
KY
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome