Abstract
Improved local control and survival rates in the treatment of rectal cancer have been reported after total mesorectal excision (TME). We performed an analysis of TME for rectal cancer by laparoscopic approach during a prospective nonrandomized trial. A prospective consecutive series of 98 laparoscopic total mesorectal excision (LTME) procedures for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncological results were reviewed. The distal limit of rectal neoplasm was on average 5.4 cm (range 3–12) from the anal verge. The mean operative time was 192.5 min (range 125–360). The conversion rate was 18.4%. The mean postoperative stay was 11.6 days (range 4–61). The 30-day mortality rate was 1% (1/98) and the overall postoperative morbidity was 18.4% including 10 anastomotic leakages. Concerning long-term oncological results, we evaluated 93 (94.8%) patients with a median follow-up of 46.3 months (range 12–132). During this period, 15.1% (14/93) died of cancer and 7.5% (7/93) are alive with metastatic disease. The portsite metastases rate was 2.1% (2/93). The locoregional pelvic recurrence rate was 2.1% (2/93): 1 stage II at 12 months and 1 stage III at 18 postoperative months, respectively. LTME is a feasible but technically demanding procedure (18.4% conversion rate). Our series confirms the safety of the procedure, while oncological results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Heald RJ, Moran BJ, Ryall RDH et al (1998) The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899
Carlsen E, Schlichting E, Gudvog I et al (1998) Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 85:526–529
Sobin LH, Wittekind C (1997) TNM classification of malignant tumours, 5th edn. Wiley
MacFarlane JK, Ryall RDH, Heald RJ (1993) Mesorectal excision for rectal cancer. Lancet 341:457–460
Fleshman JW, Wexner SD, Anvari M et al (1999) Laparoscopic vs open abdominoperineal resection for cancer. Dis Colon Rectum 42:930–939
Tomita H, Marcello PW, Milsom JW (1999) Laparoscopic surgery of the colon and rectum. Word J Surg 23:397–405
Hartley JE, Mehigan BJ, MacDonald AW et al (2000) Patterns of recurrence and survival after laparoscopic and conventional resection for colorectal carcinoma. Ann Surg 232: 181–186
Nduka CC, Monson JRT, Menzies-Gow N et al (1994) Abdominal wall metastases following laparoscopy. Br J Surg 81:648–652
Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82:295–298
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Piqué JM et al (2002) Laparoscopic-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Milsom JW, Bohm B, Hammerhofer KA et al (1998) A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: preliminary report. J Am Coll Surg 187:46–57
Lord SA, Larach SW, Ferrara A et al (1996) Laparoscopic resections for colorectal carcinoma. A three-year experience. Dis Colon Rectum 39:148–154
Bokey EL, Moore JW, Chapuis PH et al (1996) Morbidity andmortality following laparoscopicassisted right hemicolectomy for cancer. Dis Colon Rectum 39: S24–S28
Gellman L, Salky B, Edye M (1996) Laparoscopic assisted colectomy. Surg Endosc 10:1041–1044
Weeks JC, Nelson H, Gelber S et al (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328
Arbam G, Nilsson E, Hallbook O et al (1996) Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 63:375–379
Arenas RB, Fischera H, Mhoon D et al (1998) Total mesenteric excision in the surgical treatment of rectal cancer. Arch Surg 133:608–612
Enker WE, Thaler H, Cranor M et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346
Aitken RJ (1996) Mesorectal excision for rectal cancer. Br J Surg 83:214–226
Dixon AR, Maxwell WA, Thornton Holmes J (1991) Carcinoma of the rectum: a 10-years experience. Br J Surg 78:308–311
Jatzko G, Lisborg P, Welte V (1992) Improving survival rates for patients with colorectal cancer. Br J Surg 79:588–591
Cawthorn SJ, Parums DV, Gibbs NM et al (1990) Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 335:1055–1059
Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
Zaheer S, Pemberton JH, Farouk R et al (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811
Lezoche E, Feliciotti F, Paganini AM et al (2002) Laparoscopic vs open hemicolectomy for colon cancer. Surg Endosc 16:596–602
Morino M, Parini U, Giraudo G et al (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342
Leroy J, Jamali F, Forbes L et al (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289
Bretagnol F, Rullier E, Couderc P, Roullier A, Saric J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5:451–453
Philipson BM, Bokey EL, Moore JW, Chapuis PH, Bagge E (1997) Cost of open versus laparoscopically assisted right hemicolectomy for cancer. World J Surg 21:214–217
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Morino, M., Giraudo, G. (2005). Laparoscopic Total Mesorectal Excision—The Turin Experience. In: Büchler, M.W., Weitz, J., Ulrich, B., Heald, R.J. (eds) Rectal Cancer Treatment. Recent Results in Cancer Research, vol 165. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-27449-9_18
Download citation
DOI: https://doi.org/10.1007/3-540-27449-9_18
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-23341-1
Online ISBN: 978-3-540-27449-0
eBook Packages: MedicineMedicine (R0)