Laparoscopic mesorectal excision with preservation of the pelvic autonomic nerves for rectal cancer.
OBJECTIVE
Laparoscopic mesorectal excision with preservation of the autonomic pelvic nerves for rectal cancer including selected advanced lower rectal cancer is now challenging. The aims of the study were to assess the surgical results and short-term outcomes of this procedure prospectively.


METHODS
Seventy-four of 281 rectal cancer patients, since the introduction of laparoscopic colorectal surgery in our hospital, have undergone laparoscopic rectal surgery. The location of the tumor distributed in upper rectum; 33, middle; 22, and lower 19. The mesorectal excision with preservation of the autonomic pelvic nerves was performed for all the patients. The laparoscopic mesorectal excision was performed under 8 to 10 cmH2O CO2 pneumoperitoneum and lymph node dissection was performed along the feeding artery depend on individuals. Ipsilateral lateral lymph node dissection was added for 5 cases of advanced lower rectal cancer.


RESULTS
Open conversion occurred in 4 cases, 2 of those were due to locally advanced tumors and 2 technical difficulties in transaction of the distal rectum. There were 15 postoperative complications, 7 anastomotic leakage (10.6%), 3 transient urinary retention (4.1%), 4 wound infection (5.3%), and 1 small bowel obstruction (1.4%). No mortality was recorded in this series. Time of operation was 203 +/- 54 min in mesorectal excision cases and 270 +/- 42 min mesorectal excision with lateral lymph node dissection cases. Blood loss was 92 +/- 90g and 276 +/- 66 g respectively. The hospital length-of-stay was 11.7 days in average.


CONCLUSIONS
Laparoscopic mesorectal excision with preservation of autonomic pelvic nerves for rectal cancer patients including selected advanced lower rectal cancer is favorable.
Fukunaga
Yosuke
Y
Division of Gastroenterological Surgery, Osaka City General Hospital, Japan. YosukeF@aol.com
Higashino
Masayuki
M
Tanimura
Shinnya
S
Kishida
Satoru
S
Fujiwara
Yushi
Y
Ogata
Akihito
A
Osugi
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017776:Autonomic Pathways; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000294:innervation; D012004:Rectal Neoplasms / Q000601:surgery*; D016896:Treatment Outcome