Laparoscopy for rectal carcinoma: abdominoperineal excision

The enthusiasm for laparoscopic procedures in the field of visceral and colorectal surgery, in particular, has increased. Potential advantages include a reduction in pain as a result of less trauma, improved postoperative immune function, the earlier reestablishment of postoperative intestinal transit, shorter hospitalization, improved cosmesis, and reduced formation of intra-abdominal adhesions. In contrast to treatment for benign conditions, laparoscopic surgery with curative intent for malignancy is still controversial. In particular, compliance with the required criteria of oncologic radicality (extent of lymph node dissection, prevention of intraoperative tumor cell dissemination, assurance of acceptable margins of clearance) and thus, the achievement of long-term results identical with those results obtained after laparotomy, are considerations that have repeatedly been questioned. However, a number of published reports have confirmed that all the criteria for oncologic radicality in colorectal surgery can be met. An additional advantage of laparoscopic abdominoperineal excision is that it avoids a number of general problems associated with laparoscopic colorectal surgery. However, despite this encouraging information, a general recommendation for the use of laparoscopic abdominoperineal excision can be made only when definitive long-term results are available. Against this background, we discuss the questions of oncologic radicality and long-term outcome on the basis of currently available published data and our own results.