Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Mar 28, 2015; 5(1): 147-154
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.147
Feasibility and oncological outcomes of laparoscopic rectal resection following neo-adjuvant chemo-radiotherapy: A systematic review
Pawan Kumar Dhruva Rao, Manojkumar S Nair, Puthucode N Haray
Pawan Kumar Dhruva Rao, Manojkumar S Nair, Puthucode N Haray, Department of Colorectal Surgery, Prince Charles Hospital, Merthyr Tydfil CF47 9DT, Wales, United Kingdom
Puthucode N Haray, University of South Wales, Pontypridd CF37 1DL, Wales, United Kingdom
Author contributions: Dhruva Rao PK and Nair MS developed the protocol, conduced the literature search and systematic review as per protocol; Haray PN served as a referee and guided the project; all authors contributed to the manuscript.
Conflict-of-interest: All the authors are employed by the National Health Service and confirm that they have no conflicts of interest financial or otherwise to declare.
Data sharing: This is a systematic review and all data pertaining to the study have been summarized in the tables of the manuscript. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pawan Kumar Dhruva Rao, MBBS, MS, MRCSEd, Specialty Trainee in Surgery, Department of Colorectal Surgery, Prince Charles Hospital, Gurnos Rd, Merthyr Tydfil CF47 9DT, Wales, United Kingdom. pavankumar_1124@yahoo.co.in
Telephone: +44-1685-721721
Received: December 4, 2014
Peer-review started: December 4, 2014
First decision: December 12, 2014
Revised: December 23, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: March 28, 2015
Abstract

AIM: To study the feasibility and oncological outcomes following laparoscopic total mesorectal excision (LTME) in patients who have received Neo-adjuvant long course chemo-radiotherapy (LCRT).

METHODS: A protocol driven systematic review of published literature was undertaken to assess the feasibility and oncological outcomes following LTME in patients receiving LCRT. The feasibility was assessed using peri-operative outcomes and short term results. The oncological outcomes were assessed using local recurrence, disease free survival and overall survival.

RESULTS: Only 8 studies-1 randomized controlled trial, 4 Case Matched/Controlled Studies and 3 Case Series were identified matching the search criteria. The conversion rate was low (1.2% to 28.1%), anastomotic leak rates were similar to open total mesorectal excision (0%-4.1% vs 0%-8.3%). Only 3 studies reported on local recurrence rates (5.2%-7.6%) at median 34 mo follow-up. A single study described disease free survival and overall survival at 3 years as 78.8% and 92.1% respectively.

CONCLUSION: LTME following LCRT is feasible in experienced hands, with acceptable short term surgical outcomes and with the usual benefits associated with minimally invasive procedures. The long term oncological outcomes of LTME after LCRT appear to be comparable to open procedures but need further investigation.

Keywords: Laparoscopic total mesorectal excision, Rectal adenocarcinoma, Feasibility, Outcomes, Neo-adjuvant chemo-radiotherapy

Core tip: Laparoscopic total mesorectal excision (LTME) following long course chemo-radiotherapy (LCRT) is feasible in experienced hands, with acceptable short term surgical outcomes and with the usual benefits associated with minimally invasive procedures. The long term oncological outcomes of LTME after LCRT appear to be comparable to open procedures but need further investigation.