Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: long-term results of a 18-year single-centre experience.
OBJECTIVE
The oncologic efficacy of laparoscopic total mesorectal excision (TME) for middle-low rectal cancer is still under discussion because of the few long-term data. This study reports the results arising from a single-institution experience during a 18-year period.


METHODS
Data about 132 consecutive laparoscopic TME performed between January 1994 and January 2012 were analysed with Kaplan-Meier method and a uni- and multi-variate analysis was conducted to define independent survival predictors.


RESULTS
A total of 116 sphincter-preserving operations and 16 abdominoperineal resections were performed. Postoperative mortality and morbidity were 0.8 and 18.2%, with a rate of anastomotic leakage of 13.8%. Average follow-up was 85.9 months (range 13-210). Actuarial local recurrence rate was 4.13% at 5 years (any pelvic recurrence developed after 3 years from surgery). Overall and disease-free survival was respectively 83 and 79.8% at 5 years, 71 and 73% at 10 years and then remained constant until 18 years. Survival was correlated only to tumour stage and the type of surgery.


CONCLUSIONS
Laparoscopic TME for extraperitoneal rectal cancer shows long-term oncologic outcomes similar to open rectal resections.
Department of General, Laparoscopic Colorectal and Bariatric Surgery, "Umberto Parini" Regional Hospital, viale Ginevra 3, 11100, Aosta, Italy, RBRACHETCONTUL@ausl.vda.it.
Riccardo
R
Brachet Contul
Manuela
M
Grivon
Massimiliano
M
Fabozzi
Paolo
P
Millo
Mario Junior
MJ
Nardi
Stefania
S
Aimonetto
Umberto
U
Parini
Rosaldo
R
Allieta
D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D059186:Chemoradiotherapy, Adjuvant; D061887:Conversion to Open Surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors