title: Standardized laparoscopic sphincter-preserving total mesorectal excision for rectal cancer: long-term oncologic outcome in 217 unselected consecutive patients.
abstract: This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal excision (TME) on the long-term oncologic outcome of unselected patients with rectal cancer (RC).
  
  
  
  Unselected consecutive patients with histologically proven RC underwent a standardized laparoscopic TME with medial to lateral approach encompassing 9 sequential steps: (1) ligation of inferior mesenteric vessels, (2) mobilization of the left colon and sigmoid colon (medial to lateral), (3) posterior dissection of the rectum, (4) lateral mobilization of the sigmoid, left colon, and splenic flexure, (5) left and right side dissection of the rectum, (6) anterior dissection of the rectum, (7) transection of the rectum, (8) delivery of the specimen, and (9) colorectal anastomosis.
  
  
  
  From 2005 to June 2012, laparoscopic sphincter-preserving TME was attempted in 217 patients with a 6.5% conversion rate. There were 91 women and 126 men, aged 58.3 years (range, 22 to 84 y), with body mass index of 26.10 (range, 20 to 45), operative time was 150.4 minutes (range, 60 to 330 min), and 24.7 (range, 4 to 98) lymph nodes were harvested. Length of stay was 7.56 days (range, 3 to 32 d). Complication rate was 17.05%. The mean follow-up time of all patients was 36.12 months (range, 1 to 89 mo). Local recurrence rate was 3.6% and distant recurrence rate was 8.7%. The 5-year disease-free survival rates were 81.5%.
  
  
  
  A standardized laparoscopic sphincter-preserving TME resulted in a favorable short-term outcome in unselected patients with RC.
authors.affiliation: *General Surgery Department ‡Radiodiagnostic Department ∥Pathology Department, Istanbul Medical Faculty §General Surgery Department ¶Radiation Oncology Department, Oncology Institute, Istanbul University, Istanbul †Turkey Republic, Ministry of Health, Bayat State Hospital, Corum, Turkey.
authors.forename: Oktar
authors.initials: O
authors.lastname: Asoglu
authors.forename: Enver
authors.initials: E
authors.lastname: Kunduz
authors.forename: Kursat Rahmi
authors.initials: KR
authors.lastname: Serin
authors.forename: Yalin
authors.initials: Y
authors.lastname: Işcan
authors.forename: Hasan
authors.initials: H
authors.lastname: Karanlik
authors.forename: Baris
authors.initials: B
authors.lastname: Bakir
authors.forename: Gülçin
authors.initials: G
authors.lastname: Yeğen
authors.forename: Mine
authors.initials: M
authors.lastname: Gulluoglu
authors.forename: Ethem N
authors.initials: EN
authors.lastname: Oral
authors.forename: Yersu
authors.initials: Y
authors.lastname: Kapran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003106:Colon / Q000601:surgery; D012809:Colon, Sigmoid / Q000601:surgery; D044684:Colon, Transverse / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008026:Ligation; D008297:Male; D008643:Mesentery / Q000098:blood supply; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D061646:Operative Time; D011183:Postoperative Complications; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome