Cancer Res Treat.  2007 Mar;39(1):10-15.

Laparoscopic Assisted Distal Rectal Cancer Resection with Preoperative Concurrent Chemoradiotherapy

• Lee BH
• Chang MY
• Park SK
• Eum T
• Shin HJ
• Ro NK
• An CN
• Lee HW
• Kim LS
• Park HC
• Bae HS
• Zang DY
• Whelan RL

Abstract

PURPOSE: Anatomy of deep pelvis, narrow distal margin and tumor invasion into neighbor organ are obstacles for curative radical resection for advanced cancer of distal rectum. Technically, laparoscopic application after downstaging the tumor with preoperative concurrent chemotherapy (CCRT) may give a solution to overcome the anatomical difficulties. We compared the results of laparoscopic surgery in the patients who received CCRT with those of patients who had conventional surgery.
MATERIALS AND METHODS
A continuous infusion of 5FU plus leucovorin and radiotherapy (50.4 Gy) in 28 fractions was given each patient as CCRT. They underwent D2 radical resection with TME and ANP for the rectal cancer in 4 weeks.
RESULTS
Thirty three patients had laparoscopic resection such as LAR, colo-anal anastomosis and APR. The results were compared with 12 cases of the conventional resections. As a result of preoperative CCRT, the cancer was down-staged in 71%. Two year disease free survival was 75% and 74% in the group of conventional and laparoscopic resection, respectively (p=0.427). Ileus, voiding difficulty and leakage after surgery were not different between two groups. Weakness of ejaculation was noted in 9~11% of both groups. The DFS of the preoperative CCRT followed by radical resection in the groups with a response was more favorable than that in the group with progressive or stable disease.
CONCLUSION
Radical resection of advanced distal rectal cancer could be done with performing a laparoscopic assisted operation after CCRT induced down-staging. We may suggest that laparoscopic assisted resection is a good treatment option as it doesn't increase the complications and it has a compatible survival rate to conventional surgery.

Keyword

Rectum; Cancer; Radiotherapy; Chemotherapy; Laparoscopy; Survival; Complication; CCRT

MeSH Terms

Atrial Natriuretic Factor
Chemoradiotherapy*
Disease-Free Survival
Drug Therapy
Ejaculation
Fluorouracil
Humans
Ileus
Laparoscopy
Leucovorin
Male
Pelvis
Radiotherapy
Rectal Neoplasms*
Rectum
Survival Rate
Atrial Natriuretic Factor
Fluorouracil
Leucovorin

Figure

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  Fig. 1 The laparoscopic ports for trocars were placed on the lower abdomen. Ten mm port for the scope was just below the umbilicus. The main transverse incision for removal of surgical specimen was on the line of 12 mm port in the supra-pubic area with 7 cm length or more. Four 5 mm ports were located lateral to the rectus abdominis muscle. U stands for umbilicus.

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  Fig. 2 The result of down-staging after CCRT for the rectal cancer was showed along with RECIST criteria. yT stage was evaluated with 3D CT regarding size and radiologist reading. The PR and CR were in the cancers of seventy one percent of CCRT patients.

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  Fig. 3 Disease free survival (DFS) in the rectal cancer patients (n=45) with preoperative CCRT followed by radical resection in 4 weeks was plotted. DFS was 83%, 68% in one year and three year, respectively.

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  Fig. 4 Disease free survival (DFS) in conventional radical resection and laparoscopic radical resection for the rectal cancer after CCRT was plotted. The difference was not statistically significant between the two groups (p=0.427 with log rank test).

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  Fig. 5 Disease free survival (DFS) of the preoperative CCRT followed by radical resection in the groups of response (n=32) was favorable than those of progress or stable (n=13). The difference was not statistically significant (p=0.348 with log rank test).

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  Fig. 6 Disease free survival (DFS) of the preoperative CCRT followed by radical resection was worse in the groups of yT3, T4 than in those of yT0, T1, T2. There was no significant difference, statistically (p=0.275 with log rank test).

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