Laparoscopic assisted distal rectal cancer resection with preoperative concurrent chemoradiotherapy.
OBJECTIVE
Anatomy of deep pelvis, narrow distal margin and tumor invasion into neighbor organ are obstacles for curative radical resection for advanced cancer of distal rectum. Technically, laparoscopic application after downstaging the tumor with preoperative concurrent chemotherapy (CCRT) may give a solution to overcome the anatomical difficulties. We compared the results of laparoscopic surgery in the patients who received CCRT with those of patients who had conventional surgery.


METHODS
A continuous infusion of 5FU plus leucovorin and radiotherapy (50.4 Gy) in 28 fractions was given each patient as CCRT. They underwent D2 radical resection with TME and ANP for the rectal cancer in 4 weeks.


RESULTS
Thirty three patients had laparoscopic resection such as LAR, colo-anal anastomosis and APR. The results were compared with 12 cases of the conventional resections. As a result of preoperative CCRT, the cancer was down-staged in 71%. Two year disease free survival was 75% and 74% in the group of conventional and laparoscopic resection, respectively (p=0.427). Ileus, voiding difficulty and leakage after surgery were not different between two groups. Weakness of ejaculation was noted in 9 approximately 11% of both groups. The DFS of the preoperative CCRT followed by radical resection in the groups with a response was more favorable than that in the group with progressive or stable disease.


CONCLUSIONS
Radical resection of advanced distal rectal cancer could be done with performing a laparoscopic assisted operation after CCRT induced down-staging. We may suggest that laparoscopic assisted resection is a good treatment option as it doesn't increase the complications and it has a compatible survival rate to conventional surgery.
Lee
Bong Hwa
BH
Department of Surgery, Hallym University College of Medicine, Anyang, Korea. bshlee@hallym.or.kr
Chang
Mi Young
MY
Park
Sung Kook
SK
Eum
Taeik
T
Shin
Hyun Joo
HJ
Ro
Nam Kyu
NK
An
Chang Nam
CN
Lee
Hae Wan
HW
Kim
Lee Su
LS
Park
Hyoung-Chul
HC
Bae
Hoon Sik
HS
Zang
Dae Young
DY
Whelan
Richard L
RL