Surgical Margins and Short-Term Results of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer

Abstract

The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal cancer. A total of 177 patients with low rectal cancer underwent total mesorectal excision by either a laparoscopic (n = 87) or open (n = 90) approach. In all cases the surgical time, blood loss, intraoperative and postoperative complications, postoperative bowel opening, and hospital stay were assessed. Special attention was given to the macroscopic judgment concerning the cut edge of peritoneal reflection, Denonvilliers fascia, completeness of the mesorectum, and bowel wall below the mesorectum. The surgical time was 160 ± 40 minutes in the laparoscopic group. It was not significantly different from that in the open group (P = .782). The operative blood loss was 28 ± 5 mL in the group undergoing laparoscopic surgery and 80 ± 20 mL in the group undergoing open surgery (P < .01). Intraoperative injuries to the pelvic autonomic nervous system were recorded in 4 cases in the laparoscopic group compared with 12 cases in the open group (P < .05). The incidences of chest infection and anastomotic leakage were similar between the 2 approaches. The postoperative bowel opening time was 2.1 ± 1.5 days in the laparoscopic group and 3.5 ± 1.6 days in the open group (P < .01), whereas the hospital stay was 5.2 ± 1.8 days and 7.0 ± 2.1 days, respectively (P < .01). Intact Denonvilliers fascia and complete total mesorectal excision were more likely to be achieved by the laparoscopic approach than the open approach (P < .01). Colorectal anastomoses were located significantly lower in the laparoscopic group than in the open group (P < .01). Laparoscopic total mesorectal excision has consistent advantages over open total mesorectal excision, including similar surgical time, less blood loss, reduced hospital stay, and shorter disability period. A complete macroscopic specimen is more likely to be acquired by laparoscopy because of the better pelvic view offered by the approach.