Laparoscopic Total Mesorectal Excision After 450 Cases

INTRODUCTION: The laparoscopic technique is widely adopted in the surgical treatment of colorectal carcinoma. Thus, patients benefit from the usual short-term advantages of minimally invasive surgery over classical open surgery, with comparable long-term oncological results. AIM: The study presents the experience of the Clinic for General and Endoscopic Surgery of St. Ivan Rilski University Hospital in Sofia, with laparoscopic radical rectal resections for rectal carcinoma over a 14-year period and more than 450 completed laparoscopic interventions. MATERIALS AND METHODS: From January 2009 until December 2022, 454 laparoscopic curative rectal resections for rectal carcinoma were performed. Only patients with cT1–cT3 tumors, without distant metastases, were included in the study. RESULTS: The studied group included 301 (66.3%) men and 153 (33.7%) women, aged between 34 and 86 years, with an average BMI of 26 kg/m2 (21–32 kg/m2). According to the localization of the tumor in the rectum, the patients were divided as follows: proximal 1/3 (10–15 cm)—148 (32.6%); middle 1/3 (5 < 10 cm)—203(44.7%), and distal 1/3(< 5 cm)—103 (22.7%). A total of 277 (61%) patients underwent neoadjuvant chemoradiation. Eighty-five (18.7%) of the operated were in the 1st stage, 159 (35%)—in the 2nd stage, 219 (46.3%)—in the 3rd stage. Conversion was necessary in 23 cases (5.1%). The average duration of the operative intervention was 180 minutes. (120–420 min), and the blood loss was 80 mL (20–800 mL). Intestinal passage was restored on average on the 2nd postoperative day (1–7 days). The average postoperative hospital stay was 5 days (3–17 days). Complications occurred in 35 patients (7.7%). The operated patients were followed up for an average of 36 months (3–60). The overall recurrence rate was 15.6%. CONCLUSION: Laparoscopic rectal resections for carcinoma are safe interventions, characterized by less postoperative pain, less blood loss, faster bowel recovery, shorter hospital stay, and excellent cosmetic results with comparable to open surgery oncological outcomes.