Laparoscopic total mesorectal excision after neoadjuvant chemoradiotherapy.
BACKGROUND
Although several authors have demonstrated that laparoscopic total mesorectal excision (TME) is feasible, safe, and has short-term benefits over open surgery, evidence about oncological outcome is lacking. Preoperative chemoradiation has been shown to improve local control in locally advanced rectal cancer. Therefore, neoadjuvant treatment followed by laparoscopic TME has become widely used. We reviewed our series of laparoscopic TME focusing on comparison between preoperative chemoradiation therapy and primary surgery.


METHODS
Out of 59 patients who underwent laparoscopic TME, 20 were submitted to neoadjuvant chemoradiation and represent study population. Twenty-six patients with non-metastatic rectal cancer >T1 on pathologic TNM staging who underwent primary laparoscopic surgery were considered for comparison.


RESULTS
No significant differences were found in operative time, in conversions to open surgery, in intra- and postoperative complications, and in anastomotic leakage rate between the two groups. No isolated local recurrence nor port-site metastases were detected in either group. Cumulative 3-year and 5-year survivals are also similar.


CONCLUSIONS
Neoadjuvant treatment does not seem to jeopardize perioperative results of laparoscopic TME. The low incidence of local recurrence reported in both groups may be attributed to a more precise dissection allowed by the endoscopic view. Laparoscopic TME and preoperative chemoradiotherapy may significantly improve oncologic results and quality of life in patients with mid and low rectal cancer. Results should be validated by randomized trials with adequate follow-up.
Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas IRCCS, Via Manzoni 56-20089 Rozzano, Milano, Italy.
Riccardo
R
Rosati
Stefano
S
Bona
Uberto Fumagalli
UF
Romario
Ugo
U
Elmore
Niccolò
N
Furlan
D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil