title: [Laparoscopic surgery of rectal cancer: state of art and long-term results].
abstract: BACKGROUND
  From the first laparoscopic colectomy that we performed 18 years ago, several studies showed equivalent oncologic results of this technique compared to open surgery Despite this evidence traditional surgeons remain skeptical in the use of this technique, although it may favor an early return of bowel function and therefore a shorter hospitalization, as reported in recent comparative studies. Many colorectal surgeons, who have appreciated the advantages of laparoscopic colectomy, extended this approach also in rectal cancer, finding a better view in the pelvis during dissection.
  
  
  METHODS
  From 1992 to july 2009 we performed more than 400 laparoscopic resection and amputation for rectal cancer. One hundreds eighteen patients (TNM stage I-III) with a 36 month minimum follow-up were enrolled in this analysis. Converted patients to open surgery and patients staged as iT1N0 are not present in this series because we treat with local excision by TEM.
  
  
  RESULTS
  Mean operative time was 160 minutes (90-265). Mortality was 1% in 186 patients and conversion rate was 1.5%. Major complications occurred in 10.7%, including anastomotic leakage in 14 patients (7.5%) and mean hospital stay was 7.7 days. With a mean follow up of 96.8 (36-175) months in the stage I-III, the local recurrence rate was 12.5%. Systematic recurrence occurred in 13.1%.
  
  
  CONCLUSIONS
  Laparoscopic resection in rectal cancer would allow the use of the same Heald's technique, respecting the Heald's principle of meticulous dissection during total mesorectal excision, furthermore we are waiting 5 years data from randomized trials (COLOR II and CLASICC).
authors.affiliation: Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Ospedali Riuniti, Torrette, Ancona. lezocheg@me.com
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lezoche
authors.forename: Maddalena
authors.initials: M
authors.lastname: Baldarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Campagnacci
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Rimini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Organetti
authors.forename: Mario
authors.initials: M
authors.lastname: Guerrieri
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D012004:Rectal Neoplasms / Q000601:surgery*; D013997:Time Factors