Introduction In 2004, we started to perform total mesorectal excision and prophylactic lateral dissection by open surgery after preoperative chemoradiotherapy in patients with advanced lower rectal cancer. Since 2010, we have extended the radiation field to include the lateral lymph nodes and performed laparoscopic surgery for rectal cancer. Since 2013, we have laparoscopically performed lateral lymph-node dissection in patients who have enlarged lateral lymph nodes before surgery. Preoperative chemoradiotherapy can reduce tumour size, allowing a good visual field of the pelvic cavity to be obtained.
Method We focused on techniques for obtaining a good visual field of the intrapelvic cavity and on procedures for perirectal dissection and safe transection of the rectum during laparoscopic surgery for rectal cancer in patients who had received preoperative chemoradiotherapy. The study group comprised 50 patients who underwent laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy from 2010 through 2014. The primary tumour was located below the peritoneal reflection (Rb) in 40 patients and above and below the peritoneal reflection (Rab) in 10. Up to 2010, laparoscopic rectal surgery was indicated for the treatment of clinical T2 disease. Subsequently, we extended the indication to include advanced rectal cancer after chemoradiotherapy in patients with no enlarged lateral lymph nodes. From 2013 onward, we laparoscopically performed lateral lymph-node dissection in patients with enlarged lateral lymph nodes before surgery. A temporary ileostomy was performed in patients who underwent anastomosis.
Results The surgical procedures performed were low anterior resection in 29 patients, Miles’ operation in 20, and Hartmann’s surgery in 1. The operation time was 351 min. The blood loss was 125 mL. The median postoperative hospital stay was 13 days. Nine patients (18%) had postoperative complications. Suture failure occurred in 3 patients (10%) and improved after internal drainage. Ileus developed in 2 patients (4%), and perineal wound infection occurred in 2 patients (4%). The response to chemoradiotherapy was Grade 1 in 25 patients, Grade 2 in 11, and Grade 3 in 14. The pathological stage was complete response in 13 patients (26%), stage I in 12, stage II in 15, stage IIIa in 8, and stage IIIb in 2.
Conclusion Surgery for rectal cancer after chemoradiotherapy provided good results in terms of clinical response and postoperative short-term outcomes. Tumour shrinkage allowed a good field of vision to be easily obtained; surgery could thus be performed more safely and reliably.
Disclosure of interest None Declared.