Because definitive long-term results are not yet available, the oncologic safety of laparoscopic surgery in rectal cancer remains controversial. Laparoscopic total mesorectal excision (LTME) for rectal cancer has been proposed to have several short-term advantages in comparison with open total mesorectal excision (OTME). However, few prospective randomized studies have been performed. The main purpose of our study was to evaluate whether relevant differences in safety and efficacy exist after elective LTME for the treatment of rectal cancer compared with OTME in a tertiary referral medical center. This comparative nonrandomized prospective study analyzes data in 56 patients with middle and lower rectal cancer treated with low anterior resection or abdominoperineal resection from November 2005 to November 2007. Follow-up was determined through office charts or direct patient contact. Statistical analysis was performed using χ2 test and Student's t test. Twenty-eight patients underwent LTME and 28 patients were in the OTME group. No conversion was required in the LTME group. Mean operating time was shorter in the laparoscopic group (LTME) (181.3 vs 206.1 min, P < 0.002). Less intraoperative blood loss and fewer postoperative complications were seen in the LTME group. Return of bowel motility was observed earlier after laparoscopic surgery. There was no 30-day mortality and the overall morbidity was 17 per cent in the LTME group versus 32 per cent in the OTME group. The mean number of harvested lymph nodes was greater in the laparoscopic group than in the OTME group (12.1 ± 2 vs 9.3 ± 3). Mean follow-up time was 12 months (range 9-24 months). No local recurrence was found. LTME is a feasible procedure with acceptable postoperative morbidity and low mortality, however it is technically demanding. This series confirms its safety, although oncologic results are at present comparable with the OTME published series with the limitation of a short follow-up period. Further randomized studies are necessary to evaluate long-term clinical outcome.

El melanoma anorrectal es un tumor raro de origen neuroectodérmico que constituye el 1% de los tumores malignos colorrectales y entre el 0.4 y 1.6% de los melanomas en general. Habitualmente son lesiones polipoides con o sin pigmentación. En el momento del diagnóstico, el 60% de los pacientes presentan afectación ganglionar y el 20% metástasis a distancia. Para su estadifi cación, se utiliza el sistema simplifi cado de Ballantyne. Tiene un peor pronóstico en comparación con el melanoma cutáneo. La cirugía es el tratamiento de elección, pero existe una importante controversia acerca de la extensión de la resección. Caso clínico: Masculino de 50 años; inició con dolor y aumento de volumen a nivel perianal, de carácter progresivo. Fue manejado como absceso isquiorrectal y sometido a tratamiento quirúrgico en forma urgente; se identifi có una lesión neoplásica de aspecto polipoide dependiente del recto, con extensión hacia la región perianal y absceso agregado. La colonoscopia mostró obstrucción del 90% de la luz del recto distal, el reporte histopatológico de la resección-biopsia fue compatible con melanoma anorrectal. Se efectuó colostomía laparoscópica y manejo paliativo con radioterapia.