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Erschienen in: Surgical Endoscopy 1/2010

01.01.2010

Laparoscopic rectal surgery for middle and lower rectal cancer

verfasst von: Yosuke Fukunaga, Masayuki Higashino, Shinnya Tanimura, Masashi Takemura, Yushi Fujiwara

Erschienen in: Surgical Endoscopy | Ausgabe 1/2010

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Abstract

Background

The usefulness of laparoscopic low anterior resection for middle and lower rectal cancer remains controversial.

Methods

Retrospective assessment was performed on 98 patients (51 with middle and 47 with lower rectal cancer) who underwent laparoscopic rectal surgery since 1998. Total mesorectal excision was standard. Cancers were classified as middle or lower rectal based on distance from the distal tumor border to the anal verge (<8 cm or ≥8 cm). Laparoscopic rectal surgery was performed with five or six ports and carbon dioxide pneumoperitoneum. Rectal mobilization was usually done by electrocautery and vessels were sealed with a LigaSureV. Pelvic anatomy was accurately visualized by endoscopic magnification, so autonomic nerves could be preserved. The rectum was mobilized just above the levator muscles. Operative variables and the short- and long-term outcomes were investigated.

Results

Five open conversions were required, including three early cases related to rectal transection problems. The other two were for a large tumor and adhesions. Mean operating time was 236 min and blood loss was 147 g. Postoperative complications were 13 cases of anastomotic leakage (13.1%), 6 wound infections (6.1%), 4 cases of anastomotic bleeding (4.0%), and 3 cases of urinary retention (3.0%). Total morbidity was 32.2%, but there were no fatal complications or operative deaths. Mean postoperative period until bowel movement, oral intake, and hospital discharge was 1.6, 1.3, and 19.7 days, respectively. Twelve patients had recurrence: local in 3, lymph node in 2, lung in 5, and liver in 2. The 5-year disease-free/overall survival rates were 82.3/95.7% in stage I, 55.1/72.0% in stage II, and 59.5/80.7% in stage III.

Conclusion

Laparoscopic low anterior resection achieves acceptable short- and long-term outcomes. It is a useful option even for advanced lower rectal cancer.
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Metadaten
Titel
Laparoscopic rectal surgery for middle and lower rectal cancer
verfasst von
Yosuke Fukunaga
Masayuki Higashino
Shinnya Tanimura
Masashi Takemura
Yushi Fujiwara
Publikationsdatum
01.01.2010
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 1/2010
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0551-y

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