Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(3):447-450 | DOI: 10.5507/bp.2012.082

Laparoscopic abdominoperineal resection with intraoperative radiotherapy for locally advanced low rectal cancer

Matej Skrovina^a,c, Renata Soumarova^b, Miloslav Duda^a,d, Roman Bezdek^e, Jiri Bartos^a, Adam Wendrinski^b, Petr Andel^a, Javed Parvez^a, Martin Straka^a, Lukas Adamcik^a

^a Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic

^b Department of Oncology and Radiotherapy, Hospital and Oncological Centre, Novy Jicin

^c Department of Surgery I, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

^d Department of Surgery II, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc

^e Department of Anesthesiology, Hospital and Oncological Centre, Novy Jicin

Aims: Intraoperative radiotherapy (IORT) for locally advanced rectal cancer as an integral part of multimodal treatment, may lead to reduced local recurrence but it is not routinely used. The aim of this paper is to describe our experience with IORT in the treatment of patients with locally advanced adenocarcinoma of the lower third of the rectum.

Material and Methods: Laparoscopic abdominoperineal amputation of the rectum with intraoperative radiotherapy was performed on 17 patients, 13 men and 4 women, median age 64 years (49-75 years) between 2010-2011. All patients underwent complete therapy according to the treatment protocol.

Results: In one patient, the laparoscopic procedure had to be converted to an open resection. The duration of the surgical procedure with IORT was 185 to 345 min (median 285 min). In 14 cases, the intraoperative dose was 10 Gy and in two patients a dose of 12 Gy was used. There were no severe intraoperative complications. Blood loss ranged from 30 to 500 mL (median 100 mL). There were postoperative complications in 4 patients (23.5%); 2 necessitated surgical reintervention (11.8%). The duration of postoperative hospitalization was 6 to 35 days (median 7 days). In the follow-up of 2 to 16 months (median 12 months), no local recurrence or disease generalization have been found to date.

Conclusions: The results show the technical feasibility of laparoscopically assisted abdominoperineal amputation of the rectum in combination with IORT in the treatment of locally advanced rectal carcinoma with an acceptable risk of postperative complications.

Keywords: rectal cancer, surgery, intraoperative radiotherapy, laparoscopy

Received: February 29, 2012; Accepted: July 25, 2012; Prepublished online: November 2, 2012; Published: September 30, 2014  Show citation