Abstracts
1998 Digestive Disease Week

#1006

THE ROLE OF LAPAROSCOPY IN THE TREATMENT OF MID AND LOW RECTAL CANCER LESIONS. IS IT SAFE AND FEASIBLE? M.E. Franklin, D. Abrego, J.E. Balli, J.P. Dorman, J.L. Glass, H. Martinez, C. Peña. Texas Endosurgery Institute, San Antonio, Texas.

The role of Laparoscopy in Colon and Rectal disease has been criticized by many since its inception in 1990 but has become a great tool for others. Much debate has been forthcoming in the case of laparoscopic management of cancer of the colon, especially with mid and low rectal carcinoma. Evaluation of the safety and advisability of these procedures is the purpose of this study. Since 1990 thru December 1997 we have performed 345 cases of Laparoscopic colon resection for cancer, 93 of these were tumors located in the mid and low rectum and required a Low Anterior Resection. 88 were completed successfully with a conversion rate of 3.3% and a success rate of 96.7%. Very early in our experience a strict set of guidelines of oncological principles to dissect and extract the specimen was followed. In all cases the anastomosis has been carried out totally intracorporeally (97.8%) extracting the specimen through the rectum protected in a plastic bag in 90% of the cases. Anal dysfunction was present after transanal retrieval in 10% of the cases but was resolved within a month. Occasionally with tumors >5 cms in diameter the specimen was extracted transabdominally in a plastic bag. Lateral margins of all specimens were evaluated and compared to an open group of patients and felt to be equivalent or better. The average level of these tumors was at 11 cms. from the anal verge with a range of 4 to 15 cms. The average follow up in this group of patients is 31 months. The overall complication rate was 25% (17% Minor, 8% major complications). There was an anastomosis stricture rate of 3.2% and the leak rate was 1%. We have had no trocar site implants to date.

Laparoscopic Low Anterior Resection for cancer is a feasible, safe and effective procedure in our hands, with an overall complication rate and anastomotic leak and stricture problems comparably or better to standard techniques. The advantages of Minimally Invasive procedure benefits the patient with faster recuperation, less pain and essentially a non existing wound infection rate.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.