Laparoscopic total mesorectal excision-the Turin experience

Improved local control and survival rates in the treatment of rectal cancer have been reported after total mesorectal excision (TME). We performed an analysis of TME for rectal cancer by laparoscopic approach during a prospective nonrandomized trial. A prospective consecutive series of 98 laparoscopic total mesorectal excision (LTME) procedures for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncological results were reviewed. The distal limit of rectal neoplasm was on average 5.4 cm (range 3-12) from the anal verge. The mean operative time was 192.5 min (range 125-360). The conversion rate was 18.4%. The mean postoperative stay was 11.6 days (range 4-61). The 30-day mortality rate was 1% (1/98) and the overall postoperative morbidity was 18.4% including 10 anastomotic leakages. Concerning long-term oncological results, we evaluated 93 (94.8%) patients with a median follow-up of 46.3 months (range 12-132). During this period, 15.1% (14/93) died of cancer and 7.5% (7/93) are alive with metastatic disease. The port-site metastases rate was 2.1% (2/93). The locoregional pelvic recurrence rate was 2.1% (2/93): 1 stage II at 12 months and 1 stage III at 18 postoperative months, respectively. LTME is a feasible but technically demanding procedure (18.4% conversion rate). Our series confirms the safety of the procedure, while oncological results are at present comparable to the open published series with the limitation of a short follow-up period. Further studies and possibly randomized series will be necessary to evaluate long-term clinical outcome in cancer patients.