Laparoscopic Surgery Safe, Effective for Rectal Cancer

Laparoscopic interventions for rectal cancer are controversial. Oncologists have concerns about high conversion rates and long operating times associated with laparoscopic total mesorectal excision (TME), and they worry that laparoscopic TME violates the principle of sharp mesorectal dissection. With most minimally invasive surgeries improving rapidly, a team of Italian researchers has taken a closer look at laparoscopic TME. Their study appears in the September 2014 issue of the International Journal of Colorectal Disease, and suggests that laparoscopic TME’s safety and long-term results have improved considerably and are acceptable for most patients.

The researchers prospectively enrolled 186 unselected consecutive patients who had laparoscopic TME for middle and low rectal cancer between January 2001 and December 2011, and followed patients for an average of 71 months.

Among study participants, 5% were TNM stage T1, 37% were TNM stage T2, 52.5% were TNM stage T3, and 6% were TNM stage T4; half of patients had lymph node metastases. On average, surgery took 3.9 hours, and surgeons achieved complete microscopic excision in 91% of patients. The average postoperative length of hospital stay was 9 days.

Mortality and morbidity were significantly lower after laparoscopic surgery compared to open surgery. Postoperative morbidity rate after laparoscopic surgery was 24%, and 19% of patients developed surgery-related complications.

At 5 years, 77% of patients were still alive. Survival was highest for patients with stage 1 and 2 disease (89% and 81%, respectively). Survival was 43% for stage 3 disease, and 10% in stage 4 disease and 10% for stage 4. The 5-year disease-free survival rate was 66%.

Acknowledging that bowel cancer survival continues to fall beyond 5 years after diagnosis, the researchers gathered 10-year data. At ten years, survival decreased to 54%. Nine patients (4.8%) experienced a pelvic recurrence, and late metastases developed in 31 patients (17.2%).

The authors conclude that “laparoscopic TME could be considered as an essential tool in centers that perform rectal surgery.”