title: Laparoscopic abdominoperineal resection with intraoperative radiotherapy for locally advanced low rectal cancer.
abstract: OBJECTIVE
  Intraoperative radiotherapy (IORT) for locally advanced rectal cancer as an integral part of multimodal treatment, may lead to reduced local recurrence but it is not routinely used. The aim of this paper is to describe our experience with IORT in the treatment of patients with locally advanced adenocarcinoma of the lower third of the rectum.
  
  
  METHODS
  Laparoscopic abdominoperineal amputation of the rectum with intraoperative radiotherapy was performed on 17 patients, 13 men and 4 women, median age 64 years (49-75 years) between 2010-2011. All patients underwent complete therapy according to the treatment protocol.
  
  
  RESULTS
  In one patient, the laparoscopic procedure had to be converted to an open resection. The duration of the surgical procedure with IORT was 185 to 345 min (median 285 min). In 14 cases, the intraoperative dose was 10 Gy and in two patients a dose of 12 Gy was used. There were no severe intraoperative complications. Blood loss ranged from 30 to 500 mL (median 100 mL). There were postoperative complications in 4 patients (23.5%); 2 necessitated surgical reintervention (11.8%). The duration of postoperative hospitalization was 6 to 35 days (median 7 days). In the follow-up of 2 to 16 months (median 12 months), no local recurrence or disease generalization have been found to date.
  
  
  CONCLUSIONS
  The results show the technical feasibility of laparoscopically assisted abdominoperineal amputation of the rectum in combination with IORT in the treatment of locally advanced rectal carcinoma with an acceptable risk of postperative complications.
authors.affiliation: Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic.
authors.forename: Matej
authors.initials: M
authors.lastname: Skrovina
authors.forename: Renata
authors.initials: R
authors.lastname: Soumarova
authors.forename: Miloslav
authors.initials: M
authors.lastname: Duda
authors.forename: Roman
authors.initials: R
authors.lastname: Bezdek
authors.forename: Jiri
authors.initials: J
authors.lastname: Bartos
authors.forename: Adam
authors.initials: A
authors.lastname: Wendrinski
authors.forename: Petr
authors.initials: P
authors.lastname: Andel
authors.forename: Javed
authors.initials: J
authors.lastname: Parvez
authors.forename: Martin
authors.initials: M
authors.lastname: Straka
authors.forename: Lukas
authors.initials: L
authors.lastname: Adamcik
mesh_terms: D000230:Adenocarcinoma / Q000532:radiotherapy* / Q000601:surgery*; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome