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Laparoscopic Resection of the Rectum

  • Laparoscopy
  • Admission the day before surgery
  • Bowel preparation required the day before
  • Operating time 2 hours
  • No nasogastric tube
  • Drinks allowed the day after surgery
  • Resump-tion of oral diet 2 days after surgery
  • Length of hospital stay 5 days on average)
  • This proce-dure is part of our Fast Track program (enhanced recovery after surgery [ERAS] protocol)
Epidemiology 10,000 cases of rectal cancer are diagnosed every year in France. When surgical resection is possible, it is a type of cancer with good prognosis (survival > 80% at 2 years) In case of suspicion of rectal cancer, the first test to be done is a colonoscopy. Once the diagnosis is confirmed by your gastroenterologist, several additional tests are necessary:

- Endoscopic ultrasound performed by a specialised gastroenterologist. This test enables surgeons to evaluate the volume of the tumour and check for any suspicious lymph nodes (lymph node metastases) nearby.
- Thoraco-abdominopelvic CT scan
- MRI is the most accurate test for determining tumour size
- Tumor marker assay (ACE; CA19.9)

When the tumour is located in the upper part of the rectum (1/3) and there is no metas-tases, anterior resection of the rectum under laparoscopy is suggested. In the majority of cases, it is possible to restore the digestive continuity during the same procedure (no pouch needed). The rectal section is performed 5cm below the lower side of the tumor. Functional results following this procedure are good because more than 5cm of rectum are left in place. Microscopic examination of the tumour will determine whether additional chemotherapy is needed. Chemotherapy is recommended to minimise the risk of relapse. Before any therapeutic decision is made, the surgeon will confer with several specialists (oncologists, gastroenterologists, radiologists, etc.) to determine the best approach.