Laparoscopic sphincter-preserving total mesorectal excision with colonic j-pouch reconstruction : Five-year results

Thirteen years after the first report of laparoscopic colorectal surgery,1 the spotlight has drifted from technical feasibility to oncologic adequacy in cancer. While recently published randomized trials lend support to laparoscopic resection of colon cancer,2–4 skepticism prevails in laparoscopic resection of rectal cancer, in particular sphincter-preserving resection for mid and low rectal cancer.5 Laparoscopic resection of mid and low rectal cancer must conform to the current standard in rectal cancer surgery that has resulted in the lowest reported local recurrence rate,6,7 ie, total mesorectal excision (TME). Procedural complexity has limited the widespread penetration of laparoscopic sphincter-preserving TME. While there are accumulating reports that confirms technical feasibility of the procedure,8–14 its oncologic safety remains controversial. The present study reports the outcomes in 105 cases of laparoscopic TME with colonic J-pouch anal anastomosis in a 5-year period starting in 1999.