TECHNIQUE AND RESULTS OF LAPAROSCOPIC ABD OMINOPERINEAL RESECTION OF THE RECTUM

The general principles of: oncologic operations for colorectal cancer are the same for both open and laparoscopic surgery. Isolation of the tumor by occlusion of the intestinal lumen, early blockage of venous o utflow, complete resection of the lymph node bearing mesenterium, high ligation of the artery and prevention of tumor cell dissemination dur ing extirpation of the specimen are the most important factors. We pre sent our technique for laparoscopic abdominoperineal resection, which fulfills the above mentioned criteria. From June 1993 to October 1994 we operated on 19 patients (median age 68 [47-91] years; male/female r atio 10/9). Laparoscopic abdominoperineal resection of the rectum was palliative in 3 patients and curative in 16. Tumors were located 3 (1- 8) cm from the anal verge. In 3 patients the operation was converted t o open surgery. Intraoperative complications were encountered in 3 pat ients. Median operation time was 300 (200-400) minutes and postoperati ve morbidity 8/19 (42%) leading to reoperation in one patient. 30-day mortality was nil. Three patients died 5, 8 and 14 months postoperativ ely due to metastatic disease (all 3 after initial palliation). One pa tient had local recurrence and liver metastasis and died 14 months aft er operation. Another patient died from liver metastases. In one patie nt a single liver metastasis was successfully removed. 14 patients wer e tumorfree after a median follow-up of 10 (3-14) months. There was no implantation metastasis on a trocar site. Laparoscopic abdominoperine al resection of the rectum is feasible and the results are comparable with those of open surgery. Local recurrence rate and incidence of liv er metastases are comparable with open surgery after this short follow -up. However, 5-year survival is needed to judge the oncological radic ality of laparoscopic abdominoperineal resection of the rectum.