[Treatment of rectal cancer by laparoscopie]

Initiated later than for colon cancer, the evaluation of the use of laparoscopy in rectal cancer is still ongoing. Data on its feasibility and clinical tolerance are available. Evaluation has been based on better vision of total mesorectal excision down to the pelvic floor with laparoscopy. Laparoscopy may be recommended as standard practice except in the case of T4 tumours, recurrences and after certain former colorectal procedures. The conversion rate decreases with the acquisition of experience and should reach a figure below 15 %. The main causes are haemorrhages or high tumoral volume. Operating time is longer but this difference also decreases with experience. Blood loss is no different for the two techniques for identical tumoural stages. Mortality (< 3,5%) and morbidity (22 to 48 %) are also equivalent. The surgical quality of laparoscopic TEM has been contested by the Clasicc Trial data which showed a slight and non significant trend towards greater spreading of the circumferential margin for laparoscopy taking into account the fact that most of the surgeons were at the beginning of their learning curves. There was no differences in the number of lymphatic nodes retrieved. It seems that short term functional results are better with laparoscopy (bowel movements, duration of hospitalisation). Although better dissection of the hypogastric nerves was expected, worse sexual outcomes were reported thus highlighting the risk of supraradical resection. In the next few years, data from the Color II study should definitively confirm the equivalence or otherwise of laparoscopy to laparotomy in the treatment of rectal cancer.