title: Laparoscopic total mesorectal excision for rectal cancer after neoadjuvant treatment: targeting sphincter-preserving surgery.
abstract: OBJECTIVE
  Laparoscopic total mesorectal excision for rectal cancer is under scrutiny. This study aimed at analyzing feasibility, adequacy of resection, impact on early outcomes after neoadjuvant chemoradiation therapy, and to investigate trend towards indication of laparoscopy for sphincter-preservation in a single university medical center.
  
  
  METHODS
  Patients with distal rectal cancer submitted to neoadjuvant treatment followed by laparoscopic total mesorectal excision were prospectively enrolled. The studied parameters were: demographics, previous surgery, BMI, type of operation, rate of sphincter-preserving surgery, duration of surgery, conversion, specimen retrieval, lymphadenectomy, distal and radial margins, intra and postoperative morbidity, reoperations, hospital stay, and mortality.
  
  
  RESULTS
  From January 2000 to July 2010, 68 patients were enrolled. Mean age was 60 (30-87) years. There were 27 anterior and 41 abdominoperineal resections. Six patients underwent a totally laparoscopic resection and coloanal anastomosis. There was a trend (p=0.003) towards more sphincter-preserving surgery. Conversion was 4.5%. Intraoperative complication was 7.4%. Postoperative complications occurred in 15%. Mortality was 3%. Lymph-node harvest was 11 (0-33). Mean distal margin was 2.5cm (1-4). Radial margins were positive in 3 (10%) cases.
  
  
  CONCLUSIONS
  Laparoscopic total mesorectal excision after neoadjuvant treatment is feasible and safe. Sphincter-preserving laparoscopic oncologic rectal surgery has been accomplished more frequently.
authors.affiliation: Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil. sergioaraujo@colorretal.com.br
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araújo
authors.forename: Victor Edmond
authors.initials: VE
authors.lastname: Seid
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bertoncini
authors.forename: Fabio Guilherme
authors.initials: FG
authors.lastname: Campos
authors.forename: Afonso
authors.initials: A
authors.lastname: Sousa
authors.forename: Sergio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome