Prospective evaluation of laparoscopic total mesorectal excision with colonic J-pouch reconstruction for mid and low rectal cancers

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Abstract
Background Results of laparoscopic sphincter-preserving total mesorectal excision and colonic J-pouch reconstruction are few. The aim of this study was to examine outcomes after this procedure. Methods Patients with mid or low rectal cancer underwent laparoscopic total mesorectal excision with construction of a colonic J pouch, performed by a single surgeon. The patients were evaluated prospectively. Results From March 1999 to January 2002, 44 patients underwent laparoscopic total mesorectal excision with colonic J-pouch reconstruction. There were 21 men and 23 women of median age 65·5 years. The median operating time was 180 min and median blood loss 80 ml. There was no conversion to an open procedure. The median distance of the anastomosis from the anal verge was 4 cm. No procedure-related death occurred. Four patients developed significant complications that required reoperation. With a median follow-up period of 15 months, no port-site recurrence was noted. Five patients developed distant metastases, and two had local recurrence in the pelvis. Bowel function was satisfactory at 6, 12 and 18 months after ileostomy closure. Conclusion Laparoscopic total mesorectal excision with colonic J-pouch reconstruction is safe, with a reasonable operating time. Early results suggest satisfactory oncological control and functional outcomes.