Laparoscopic abdominosacral composite resection for locally advanced primary rectal cancer

Abstract

En bloc resection of a primary rectal cancer that involves the sacrum is the only curative option for such locally advanced tumours. There is significant morbidity associated with this surgical procedure. A laparoscopic component would potentially provide the patient with the short-term benefits of a minimally invasive approach to the abdominal phase of this challenging operation. The aim of this study was to assess our initial experience with a combined laparoscopic and transsacral approach. A prospective review of patients carefully selected for a laparoscopic abdominosacral composite resection by a single colorectal multidisciplinary team. Three male patients underwent the procedure. Median duration of surgery was 190 minutes and no blood transfusion was required. Two patients had full intestinal function on the second postoperative day and went home on day 12 and 13. The third patient had a laparotomy for postoperative small-bowel obstruction. All three patients had a R0 (complete) resection with a median lymph node harvest of 15 nodes. A laparoscopic proctectomy provides an oncologically sound and minimally invasive option to the abdominal phase of this composite operation. We will continue to gain experience with this combined approach in order to lessen the inevitable morbidity inflicted on the patient in the quest for cure of their locally advanced disease.