Evaluation of The Feasibility and Safety of Laparoscopic Rectal Resection for Rectal Carcinoma After Neoadjuvant Chemoradiation

Purpose: This study aimed to evaluate the technical feasibility and oncological safety of laparoscopic total mesorectal excision (TME) for rectal carcinoma after chemoradiotherapy.Methods: 30 Patients with T3, T4 and⁄ or N1-2 rectal cancer were subjected to a preoperative neoadjuvant chemoradiotherapy (nCRT) protocol in the form of 45-50 Gy of external irradiation over 25-28 weekly fractions to the true pelvis concomitant with oral Capecitabine 825 mg/m2 twice daily.Results: This study included 16 males (53.3%) and 14 females (46.7%) with a mean age of 48.63 ±12.53 years. 19 patients (63.3%) underwent laparoscopic low anterior resection (LLAR) while 11 patients (36.7%) underwent laparoscopic abdominoperineal resection (LAPR). Mean blood loss was 66.05 ± 31.60 cc in LAR group and 241.82 ± 101.37 cc in APR group, the operative time was longer in APR group. The intra-operative adverse events occurred in 7 patients (23.3%). Earlier recovery of bowel function was observed in both groups; with shorter postoperative hospital stay in LLAR vs LAPR groups. Involvement of the circumferential resection margin occurred in two cases (6.7%), the mean number of harvested lymph nodes was 10.57±1.74 lymph node, the distal and proximal resection margins were free from malignant infiltration in all cases. Postoperative morbidity occurred in 8 patients (26.7%) with one case of local recurrence (3.3%).Conclusions: Based on the controllable surgical complications, minimal invasiveness and achieved oncological safety in the current patient series, laparoscopic TME is shown to be technically feasible and oncologically safe and can be recommended for patients with rectal carcinoma requiring preoperative chemoradiotherapy.