Laparoscopic sphincter-preserving rectal cancer surgery: a highly demanding procedure

Excerpt

Most patients with potentially curable middle or lower rectal cancer at diagnosis prefer or require a sphincter-preserving surgical procedure. Currently, laparoscopic low anterior resection (LLAR) is thought to offer the best possible postoperative quality of life (QOL) [1, 2]. However, what are the risks of postoperative complications and local or locoregional failures? Are there standardized criteria for a safe and effective LLAR? Is preoperative (neoadjuvant) chemoradiotherapy beneficial to all patients or only in selected cases? To evaluate these questions, Fukunaga et al. [3] performed a retrospective analysis which was reported in the January 2010 issue of this journal. Clinicopathologic treatment and follow-up data of 98 patients with middle (n = 51) or low-lying rectal cancer (n = 47) who underwent laparoscopic rectal surgery were studied. Depending on the distal distance of the distal tumor border to the anal verge, the patients were classified as having lower (<8 cm) or middle (≥8 cm) rectal cancer. Total mesorectal excision (TME) was performed in all patients. Pelvic anatomy was accurately visualized by endoscopic magnification so autonomic nerves could be preserved. Conversion to open surgery was necessary in five patients because of difficulties with rectal transection in three early cases and a large tumor and adhesions in the other two. Overall, the postoperative complication rate was 32.2%, with an anastomotic leakage rate of 13.1%. Recurrence occurred in 12 patients: 3 local, 2 lymph nodes, and 7 distant failures. …