title: Laparoscopic surgery in rectal cancer: a prospective analysis of patient survival and outcomes.
abstract: OBJECTIVE
  The role of laparoscopic resection in the management of rectal cancer is still controversial. We prospectively evaluated patient survival and outcomes in patients undergoing laparoscopic rectal resection for rectal cancer at a single institution.
  
  
  METHODS
  From November 1999 to November 2005, 107 patients with rectal cancer were treated by laparoscopy. Exclusion criteria were: metastatic disease, advanced disease with invasion of adjacent structures, clinical or radiologic involvement of the external anal sphincter, previous colonic resection, synchronous colonic adenocarcinoma, and contraindications to laparoscopy. All patients were followed prospectively for survival and complications. Survival was calculated by the Kaplan-Meier method.
  
  
  RESULTS
  A laparoscopic sphincter-saving procedure was performed in 104 patients, 2 patients had a laparoscopic Miles operation, and 1 underwent a laparoscopic Hartmann's procedure. Mean operating time was 278 (range, 135-430) minutes. Conversion to open surgery was required in 20 of 107 patients (18.7 percent). Overall morbidity was 27 percent, anastomotic leakage occurred in 14 of 104 patients (13.5 percent). There was no postoperative mortality. A mean of 18 (range, 1-49) lymph nodes was removed. Mean distance of distal margin from tumor was 2.6 (range, 0.5-10) cm; in two patients there was microscopic invasion of the distal margin. Mean hospital stay was nine (range, 4-43) days. Mean follow-up was 35.8 months. There was local recurrence in 1 of 107 patients (0.95 percent); there were no port site metastases. Actuarial five-year and disease-free survival rates are 81.4 and 79.8 percent, respectively.
  
  
  CONCLUSIONS
  Laparoscopic rectal surgery is feasible and oncologically radical but also technically demanding (conversion rate, 18.7 percent), time-consuming (mean operating time, 278 minutes), and associated with specific intraoperative complications. At present, the technique should only be performed in specialist centers by teams experienced in laparoscopic surgery.
authors: Department of General Surgery, University of Milan, Istituto Clinico Humanitas IRCCS, Rozzano, Milano, Italy. paolopietro.bianchi@fastwebnet.it
authors: Paolo Pietro
authors: PP
authors: Bianchi
authors: Riccardo
authors: R
authors: Rosati
authors: Stefano
authors: S
authors: Bona
authors: Matteo
authors: M
authors: Rottoli
authors: Ugo
authors: U
authors: Elmore
authors: Chiara
authors: C
authors: Ceriani
authors: Alberto
authors: A
authors: Malesci
authors: Marco
authors: M
authors: Montorsi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003082:Colectomy / Q000379:methods*; D003113:Colonoscopy; D018572:Disease-Free Survival; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome