title: Quality of surgery for rectal carcinoma: comparison between open and laparoscopic approaches.
abstract: BACKGROUND
  Macroscopic evaluation of a tumor specimen is an independent prognostic factor of oncologic outcome after total mesorectal excision (TME) for rectal cancer. This study aimed to assess macroscopic quality of specimens acquired after laparoscopic versus open TME in patients with low rectal cancer.
  
  
  METHODS
  Seventy-two patients with low rectal cancer underwent TME either by open (n = 39) or laparoscopic (n = 33) approach. In all specimens, the cut edge of the peritoneal reflection at the anterior mid-rectum, the Denonvillier's fascia, the visceral fascia covering the mesorectum both posteriorly and laterally, and the bowel wall below the mesorectum were macroscopically assessed.
  
  
  RESULTS
  Colorectal anastomoses were located significantly lower in the laparoscopic than in the open group (P < .001). The Denonvillier's fascia was violated in 7 patients after open surgery (P = .01). A significantly more complete TME with intact visceral pelvic fascia was performed after laparoscopy compared with open surgery (P = .025).
  
  
  CONCLUSIONS
  Laparoscopy offers a macroscopically more complete specimen after TME for rectal cancer than the open approach because it offers a better view in the pelvis.
authors.affiliation: The Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece. nikos.gouvas@gmail.com
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Gouvas
authors.forename: John
authors.initials: J
authors.lastname: Tsiaoussis
authors.forename: George
authors.initials: G
authors.lastname: Pechlivanides
authors.forename: Anastasios
authors.initials: A
authors.lastname: Tzortzinis
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Costas
authors.initials: C
authors.lastname: Avgerinos
authors.forename: Evaghelos
authors.initials: E
authors.lastname: Xynos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery