title: The implementation of a standardized approach to laparoscopic rectal surgery.
abstract: OBJECTIVE
  The purpose of this study was to audit our results after implementation of a standardized operative approach to laparoscopic surgery for rectal cancer within a fast-track recovery program.
  
  
  METHODS
  From January 2009 to February 2011, 100 consecutive patients underwent laparoscopic surgery on an intention-to-treat basis for rectal cancer. The results were retrospectively reviewed from a prospectively collected database. Operative steps and instrumentation for the procedure were standardized. A standard perioperative care plan was used.
  
  
  RESULTS
  The following procedures were performed: low anterior resection (n = 26), low anterior resection with loop-ileostomy (n = 39), Hartmann's operation (n = 14), and abdominoperineal resection (n = 21). The median length of hospital stay was 7 days; 9 patients were readmitted There were 9 cases of conversion to open surgery. The overall complication rate was 35%, including 6 cases (90/%) of anastomotic leakages requiring reoperation. The 30-day mortality was 5%. The median number of harvested lymph nodes was 15 (range, 2 to 48). There were 6 cases of positive circumferential resection margins. The median follow-up was 9 (range, 1 to 27) months. One patient with disseminated cancer developed port-site metastasis.
  
  
  CONCLUSIONS
  The results confirm the safety of a standardized approach, and the oncological outcomes are comparable to those of similar studies.
authors.affiliation: Department of Surgical Gastroenterology, Hvidovre University Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Katrine Kanstrup
authors.initials: KK
authors.lastname: Aslak
authors.forename: Orhan
authors.initials: O
authors.lastname: Bulut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control; D054869:Clinical Audit; D061887:Conversion to Open Surgery; D013505:Digestive System Surgical Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D010535:Laparoscopy / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome