Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy.
BACKGROUND
Total mesorectal excision (TME) with preoperative chemoradiation therapy is an accepted standard treatment for low rectal cancer. Although the laparoscopic approach is accepted for the treatment of colon cancer, its value for low rectal cancer is unknown. The purpose of this study was to evaluate whether preoperative chemoradiation therapy exerted an adverse influence on laparoscopic TME for low rectal cancer.


METHODS
We studied 125 consecutive patients who underwent laparoscopic TME for low rectal cancer. Twenty patients with preoperative chemoradiation therapy (CRT-Lap group) were compared with 105 patients without chemoradiation therapy (non-CRT-Lap group).


RESULTS
Operating time in the CRT-Lap group (276 min, range 160-390 min) was no different from that in the non-CRT-Lap group (263 min, range 143-456 min). The CRT-Lap group had more blood loss during the operation (70 vs. 37 ml), but mean blood loss was <100 ml. The distal tumor margin was longer in the CRT-Lap group (25.8 vs. 18.6 mm). The number of lymph node harvested did not differ between the groups (14.5 vs. 15.4). Conversion to open surgery was necessary only in one case in the non-CRT-Lap group. There was no anastomotic leakage in the CRT-Lap group, whereas three patients (3.1%) had anastomotic leakage in the non-CRT-Lap group.


CONCLUSIONS
Laparoscopic TME with preoperative chemoradiation therapy is a safe procedure with reasonable operating time and does not appear to pose any threat to the surgical and oncologic outcomes.
Akiyoshi
Takashi
T
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 3-10-6, Ariake, Koto-ku, Tokyo 135-8550, Japan.
Kuroyanagi
Hiroya
H
Oya
Masatoshi
M
Konishi
Tsuyoshi
T
Fukuda
Meiki
M
Fujimoto
Yoshiya
Y
Ueno
Masashi
M
Yamaguchi
Toshiharu
T
Muto
Tetsuichiro
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil