Laparoscopic rectal resection for primary rectal cancer combined with open upper major abdominal surgery: Initial experience

Background/Aims: Although laparoscopy is accepted for treatment of colon cancer, its use for rectal cancer still has technical limitations. Whether a laparoscopic approach for rectal cancer is safe and beneficial remains unknown when simultaneous open upper major abdominal surgery is planned. Methodology: Eight patients underwent laparoscopic rectal resection for primary rectal cancer combined with open upper major abdominal surgery. Results: All laparoscopic rectal resections were successful, with no conversion to open surgery. Surgical procedures included two anterior, four low or superlow anterior, and two abdominoperineal resections. There were five simultaneous liver resections for suspected synchronous liver metastasis and three gastrectomies for advanced gastric cancer. Mean operating time was 517 (377-745) min, including 235 (165-330) min for rectal resection. Mean estimated blood loss was 398 (45-1200) mL, including 78 (0-550) mL for rectal resection. There was no postoperative morbidity. Overall morbidity was lower (0 vs. 47%) and time to flatus and liquid diet was faster (2.1 vs. 3.4 and 3.5 vs. 5.6 days, respectively) in the laparoscopic resection group compared with the open group with synchronous open upper major abdominal surgery. Conclusions: This preliminary report suggests that laparoscopic rectal resection for rectal cancer combined with open upper major abdominal surgery is a safe and feasible option in selected patients.