Clinical Comparison Of Laparoscopic And Open Total Mesorectal Excision In The Treatment Of Rectal Cancer

Objective To evaluate the feasibility,safety and short-term and long-term outcome oflaparoscopic total mesorectal excision(LTME) with sphincter preservation in comparison with open procedure for rectal cancer.Methods From April 2004 to April 2007, 25 cases of laparoscopic total mesorectalexcision with sphincter preservation in the treatment of rectal cancer were enrolled in this study. The intraoperative risk,recovery ,short-term and long-term outcomes of these patients were compared with 25 conventional Dixon's operation in a pair analysis. The controls,matched for age, sex, mass margin distance from the anus , Dukes stage, were selected from conventional Dixon's operations performed at the same period as laparoscopic group. Results 24 cases in laparoscopic group were performed successfully while conversion to Bacon operation was required in 1 case. The mean operation time (197.1±35.5 ) mins in laparoscopic group,significantly longer than those (171.6±50.7)mins in open group(p<0.05).The mean operative blood loss was (156.6±105.2)ml in laparoscopic group and (304.1±236.7) ml in open group(p<0.05).No significant differences were detected between two groups in specimen length,distal margin, and number of lymph nodes excised. The bowel function was restored earlier in laparoscopic group than that in open group. The overall morbidity rates were 16% and 28%,and the local recurrence rates were 8% and 4% in the two group respectively.Conclusion LTME is a feasible ,safe and minimally invasive technique for rectal cancer,which can get radical effect of TME,and provide better short-term and long-term outcomes compared with the traditional open procedure.