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Laparoscopic total mesorectal excision-the Turin experience
1II Department of Surgery, University of Turin, 14 C. so A.M. Dogliotti, 10126 Turin, Italy. mario.morino@unito.it
Summary
Laparoscopic total mesorectal excision (LTME) is a feasible surgical approach for rectal cancer, offering comparable oncological outcomes to open surgery. While technically demanding, LTME demonstrates safety and effectiveness in local control and survival rates.
Area of Science:
- Surgical Oncology
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Total mesorectal excision (TME) improves outcomes in rectal cancer treatment.
- Laparoscopic approaches offer potential benefits in minimally invasive surgery.
Purpose of the Study:
- To analyze the feasibility, safety, and oncological outcomes of laparoscopic total mesorectal excision (LTME) for rectal cancer.
- To evaluate clinical and oncological results in a prospective nonrandomized trial.
Main Methods:
- Prospective analysis of 98 consecutive laparoscopic total mesorectal excision (LTME) procedures for low and mid-rectal tumors.
- All patients underwent sphincter-saving procedures.
- Review of case selection, surgical technique, and clinical/oncological outcomes.
Main Results:
- Mean operative time: 192.5 minutes; conversion rate: 18.4%.
- 30-day mortality: 1%; postoperative morbidity: 18.4% (including 10 anastomotic leakages).
- Median follow-up: 46.3 months; cancer-specific mortality: 15.1%; metastatic disease: 7.5%; port-site metastases: 2.1%; locoregional recurrence: 2.1%.
Conclusions:
- LTME is a feasible yet technically demanding procedure for rectal cancer.
- Oncological results appear comparable to open TME series, though follow-up is limited.
- Further studies, including randomized trials, are needed to confirm long-term outcomes.