Abstract
Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients’ demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.
Highlights
The treatment of rectal cancer has been thoroughly discussed in a considerable number of published studies [1,2,3,4] with a remarkable evolution in the technical aspects and the outcomes achieved
The study was conducted on 20 patients with distal rectal cancer who underwent laparoscopic abdominoperineal resection with total mesorectal excision (TME)
Heald first described TME for rectal cancer surgery in 1979 [9], he devised sharp under vision dissection of the mesorectum in an avascular plane which allows the preservation of the autonomic nerves [10]
Summary
The treatment of rectal cancer has been thoroughly discussed in a considerable number of published studies [1,2,3,4] with a remarkable evolution in the technical aspects and the outcomes achieved. All efforts in rectal cancer surgery have been directed towards two essential objectives: ensuring radical eradication of the tumor, and maintaining an acceptable level of life quality by avoiding permanent stoma [4]. This has been clearly reflected in the increasing use of anal sphincter preserving procedures and the routine performance of total mesorectal excision (TME) whether through an abdominal or transanal approach. The mesorectum is not a true mesentery but rather a fatty tissue that envelops the rectum and in which the blood and lymphatic vessels, lymph nodes and autonomic nerves are carried From this anatomic perspective we can expect that localized rectal cancer
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