Total mesorectal excision

Abstract

Totally laparoscopic excision of the mesorectum is feasible in 50 percent of patients and where possible yields histologic parameters comparable to open surgery. Early survival and recurrence figures also appear to be comparable.

Short-term outcomes of laparoscopic total mesorectal excision following neoadjuvant chemoradiotherapy

“…The currently reported conversion rate of 28% is very similar to the rates reported by Hartley et al [18] and by the CLASICC [9] trial. This feature is related to the fact that the majority of our patients since 2005 were offered laparoscopic surgery.…”

Laparoscopy for Colorectal Malignancy

“…It is well established that the widest possible radial tumour clearance should be undertaken with rectal cancer, as the presence of histologically positive circumferential resection margins is associated with rates of local recurrence in excess of 80% [44, 45]. We have shown previously that it is feasible to perform a totally laparoscopic excision of the mesorectum, in a cohort study comparing laparoscopic with open excision [14]. A single colorectal pathologist, blind to the method of resection, assessed all the specimens according to the standard techniques, as described by Quirke et al [44].…”

“…There are a number of concerns such as the ability of the laparoscopic approach to allow a precise total mesorectal excision, as championed by Heald and Ryall [11]. Such concerns are appropriate; however, studies to date have consistently failed to demonstrate any detriment in terms of disease recurrence and survival consequent to a laparoscopic approach to colorectal cancer [12,13,14,15,16,17]. …”

“…Port-site herniation can be largely prevented by the meticulous closure of all port sites >10 mm. Operative complications such as major haemorrhage, inadvertent enterotomy, ureteral injury, and major vessel laceration have all been reported, with rates ranging from 0 to 12% [6, 12, 14, 46, 51, 56, 57, 59]. The overall morbidity rate is between 6 and 39% [59,68,69,70,71,72,73,74,75,76,77].…”

“…Conversion is more likely with left-sided and rectal dissections, and the rates do appear to reduce with experience. Rates ranging from 1.45 to 48% have been reported, with a mean conversion rate for collated series of around 17.5% [see 12, 14, 46, 56, 57, 59]. It is important that patients are counseled appropriately.…”