title: Laparoscopic rectal resection for primary rectal cancer combined with open upper major abdominal surgery: initial experience.
abstract: OBJECTIVE
  Although laparoscopy is accepted for treatment of colon cancer, its use for rectal cancer still has technical limitations. Whether a laparoscopic approach for rectal cancer is safe and beneficial remains unknown when simultaneous open upper major abdominal surgery is planned.
  
  
  METHODS
  Eight patients underwent laparoscopic rectal resection for primary rectal cancer combined with open upper major abdominal surgery.
  
  
  RESULTS
  All laparoscopic rectal resections were successful, with no conversion to open surgery. Surgical procedures included two anterior, four low or super-low anterior, and two abdominoperineal resections. There were five simultaneous liver resections for suspected synchronous liver metastasis and three gastrectomies for advanced gastric cancer. Mean operating time was 517 (377-745) min, including 235 (165-330) min for rectal resection. Mean estimated blood loss was 398 (45-1200) mL, including 78 (0-550) mL for rectal resection. There was no postoperative morbidity. Overall morbidity was lower (0 vs. 47%) and time to flatus and liquid diet was faster (2.1 vs. 3.4 and 3.5 vs. 5.6 days, respectively) in the laparoscopic resection group compared with the open group with synchronous open upper major abdominal surgery.
  
  
  CONCLUSIONS
  This preliminary report suggests that laparoscopic rectal resection for rectal cancer combined with open upper major abdominal surgery is a safe and feasible option in selected patients.
authors.affiliation: Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kuroyanagi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Oya
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Ohyama
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
authors.forename: Rintaro
authors.initials: R
authors.lastname: Koga
authors.forename: Makoto
authors.initials: M
authors.lastname: Seki
authors.forename: Naoki
authors.initials: N
authors.lastname: Hiki
authors.forename: Tetsu
authors.initials: T
authors.lastname: Fukunaga
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Meiki
authors.initials: M
authors.lastname: Fukuda
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D006498:Hepatectomy; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome