title: Quality of mesorectum after laparoscopic resection for rectal cancer - results of an audited teaching programme in Spain.
abstract: OBJECTIVE
  The aim of this prospective observational study was to compare the quality of total mesorectal excision between laparoscopic and open surgery for rectal cancer.
  
  
  METHODS
  In April 2006, the Spanish Association of Surgeons started an audited teaching programme. The project was similar to the Norwegian one and several training courses were arranged. Patients were classified into two groups: laparoscopic rectal resection (LR) and open rectal resection (OR). The quality of the mesorectum was scored: complete, nearly complete or incomplete. The circumferential margin (CRM) was considered positive, if tumour was located 1 mm or less from the surface of the specimen.
  
  
  RESULTS
  Between 2006 and 2008, 604 patients underwent rectal resection with total mesorectal excision for rectal cancer: 209 patients were included in the LR group and 395 patients in the OR group. There were no differences in terms of number of lymph nodes affected, distance of the tumour from CRM. The mesorectum was complete in 464 (76.8%), nearly complete in 91 (15.1%) and incomplete in 49 patients (8.1%). CRM was negative in 534 patients (88.4%). No differences were observed between the two groups. The overall postoperative morbidity rate was 38.8% in LR group and 44.6% in OR group (P = 0.170). Overall postoperative mortality rate was 2.5%. One patient died (0.5%) in the LR group and 14 patients died (3.5%) in the OR group (P = 0.021).
  
  
  CONCLUSIONS
  Laparoscopic resection for rectal cancer is feasible with the quality of mesorectal excision and postoperative outcomes similar to those of open surgery.
authors.affiliation: Department of Surgery, Colorectal Unit, Hospital Universitario de Bellvitge, 08907 Barcelona, Spain. sebastianobiondo@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Biondo
authors.forename: H
authors.initials: H
authors.lastname: Ortiz
authors.forename: J
authors.initials: J
authors.lastname: Lujan
authors.forename: A
authors.initials: A
authors.lastname: Codina-Cazador
authors.forename: E
authors.initials: E
authors.lastname: Espin
authors.forename: E
authors.initials: E
authors.lastname: Garcia-Granero
authors.forename: E
authors.initials: E
authors.lastname: Kreisler
authors.forename: M
authors.initials: M
authors.lastname: de Miguel
authors.forename: R
authors.initials: R
authors.lastname: Alos
authors.forename: A
authors.initials: A
authors.lastname: Echeverria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D013505:Digestive System Surgical Procedures / Q000193:education* / Q000379:methods*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008643:Mesentery / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D021701:Sentinel Lymph Node Biopsy / Q000193:education* / Q000379:methods; D013030:Spain