title: Laparoscopic resection of rectal cancer.
abstract: BACKGROUND
  The treatment of rectal cancer has changed significantly over the last few decades. Advanced surgicil techniques have led to an increase in the rate of sphincter-preserving operations, even for low rectal tumors. This was facilitated by preoperative oncologic treatment and the use of chemoradiation to downstage the tumor before resection. The introduction of total mesorectal excision further improved the oncologic outcome and became the standard of care. The use of laparoscopy for rectal resection is the most recent addition to this series of improvements, but in contrast to the use of laparoscopy in colon cancer its role is not yet well defined.
  
  
  OBJECTIVE
  To present our experience with laparoscopic surgery for upper and lower rectal tumors.
  
  
  METHODS
  A database was used to prospectively collect all data on laparoscopic rectal surgery in our department since we started performing these procedures in 1997. Follow-up data were collected from outpatient clinic visits, oncology files and telephone interviews. Updated survival data were retrieved from the national census.
  
  
  RESULTS
  Of 750 laparoscopic colorectal procedures performed over a 13 year period, 67 were for rectal cancer. Of these, 29 were resections for tumors in the upper rectum (11-15 cm from the analverge) and 38 for tumors at 10 cm or below. Surgery was performed in 24 patients after neoadjuvant chemoradiation. There were 54 sphincter-preserving operations and 13 abdominoperineal resections. The mean operative time was 283 minutes. Conversion to an open procedure was required in 22% of the cases. Anastomotic leaks occurred in 17% of cases. Postoperative mortality was 4.5%. Long-term follow-up was available for 77% of the group, for a mean period of 42 months. Local recurrence was diagnosed in 4.5% of the patients and overall 5 year survival was 68%.
  
  
  CONCLUSIONS
  Laparoscopic rectal resection is a demanding procedure. However, laparoscopy may become the preferred approach since it is a minimally invasive procedure and has an acceptable oncologic outcome that is comparable to that with the open approach. This conclusion, however, needs further validation.
authors.affiliation: Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. drosin@mac.com
authors.forename: Danny
authors.initials: D
authors.lastname: Rosin
authors.forename: Alexander
authors.initials: A
authors.lastname: Lebedyev
authors.forename: Damien
authors.initials: D
authors.lastname: Urban
authors.forename: Dan
authors.initials: D
authors.lastname: Aderka
authors.forename: Oded
authors.initials: O
authors.lastname: Zmora
authors.forename: Marat
authors.initials: M
authors.lastname: Khaikin
authors.forename: Aviad
authors.initials: A
authors.lastname: Hoffman
authors.forename: Moshe
authors.initials: M
authors.lastname: Shabtai
authors.forename: Amram
authors.initials: A
authors.lastname: Ayalon
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology; D013505:Digestive System Surgical Procedures; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data