Chirurgia laparoscopica del cancro del retto. Stato dell’arte e risultati a lungo termine


Giovanni Lezoche, Maddalena Baldarelli, Roberto Campagnacci, Massimiliano Rimini, Lorenzo Organetti, Mario Guerrieri

Ann. Ital. Chir., 2010; 81: 265-268

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BACKGROUND: From the first laparoscopic colectomy that we performed 18 years ago, several studies showed equivalent
oncologic results of this technique compared to open surgery. Despite this evidence traditional surgeons remain skeptical
in the use of this technique, although it may favor an early return of bowel function and therefore a shorter hospitalization,
as reported in recent comparative studies. Many colorectal surgeons, who have appreciated the advantages of
laparoscopic colectomy, extended this approach also in rectal cancer, finding a better view in the pelvis during dissection.
METHOD: From 1992 to july 2009 we performed more than 400 laparoscopic resection and amputation for rectal cancer.
One hundreds eighteen patients (TNM stage I-III) with a 36 month minimum follow-up were enrolled in this
analysis. Converted patients to open surgery and patients staged as iT1N0 are not present in this series because we treat
with local excision by TEM.
RESULTS: Mean operative time was 160 minutes (90-265). Mortality was 1% in 186 patients and conversion rate was
1.5%. Major complications occurred in 10.7%, including anastomotic leakage in 14 patients (7.5%) and mean hospital
stay was 7.7 days. With a mean follow up of 96.8 (36-175) months in the stage I-III, the local recurrence rate
was 12.5%. Systematic recurrence occurred in 13.1%.
CONCLUSION: Laparoscopic resection in rectal cancer would allow the use of the same Heald’s technique, respecting the
Heald’s principle of meticulous dissection during total mesorectal excision, furthermore we are waiting 5 years data from
randomized trials (COLOR II and CLASICC).