title: Laparoscopic total mesorectal excision for extraperitoneal rectal cancer: long-term results.
abstract: The long-term role of laparoscopy in the treatment of rectal cancer is still controversial. The aim of the present study was to evaluate the safety, the feasibility, the perioperative outcome, and the long-term results of laparoscopic total mesorectal excision (TME) for extraperitoneal rectal cancer considering a single center series.
  
  
  METHODS
  Data about 186 unselected consecutive patients that underwent laparoscopic TME for middle and low rectal cancer between January 2001 and December 2011 were prospectively recorded and were included in the present study.
  
  
  RESULTS
  Distribution of TNM stage was 5 % T1, 37 % T2, 52.5 % T3, and 6 % T4. Fifty-one percent of patients have lymph node metastases. The average duration of surgery was 234 min. Fourteen patients required conversion (7.5 %). A complete microscopic excision was achieved in 169 patients (91 %). The mean hospital stay was 9 days. The overall postoperative morbidity rate was 24 %. Surgical-related complications were reported in 19 %. Overall mortality was 0.5 %. Sex, tumor level, and the presence of a stoma were the only statistically significant independent risk factors for anastomotic leakage. Median follow-up was 71 months. The 5-year overall survival rate was 77 %, with 89 % for stage 1, 81 % for stage 2, 43 % for stage 3, and 10 % for stage 4. The 5-year disease-free survival rate was 66 %. The 10-year survival rate was 54 %. Nine patients (4.8 %) experienced a pelvic recurrence. Late metastases developed in 31 patients (17.2 %).
  
  
  CONCLUSIONS
  The study confirms the oncological safety of laparoscopic TME in a long follow-up period.
authors.affiliation: General, Emergency and Mini-invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy, jamjac64@hotmail.com.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Martellucci
authors.forename: Carlo
authors.initials: C
authors.lastname: Bergamini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bruscino
authors.forename: Paolo
authors.initials: P
authors.lastname: Prosperi
authors.forename: Pietro
authors.initials: P
authors.lastname: Tonelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Todaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Valeri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D015996:Survival Rate