Five-year oncological outcomes for rectal cancer treated by upfront laparoscopic total mesorectal excision

Aim The study aimed to evaluate the long-term recurrence rates and survival following upfront laparoscopic total mesorectal excision (TME) for rectal adenocarcinoma. Patient and Methods This was a retrospective cohort of 94 patients with rectal adenocarcinoma undergoing upfront radical resection in New Territories West Cluster between 2010 and 2015. Tumours with safe circumferential resection margin (>1 mm) on magnetic resonance imaging (MRI) staging were selected for upfront surgery. Demographic data, tumour characteristics, operative details, and histopathological and postoperative outcomes were collected from patients' records. The primary outcome was local recurrence. Secondary outcomes were distant recurrence and overall (OS) and disease-free survival (DFS). Results A total of 224 patients were diagnosed with rectal adenocarcinoma, of which 94 received upfront surgery after a multidisciplinary team discussion by surgeons and oncologists. The median follow-up period after surgery was 60 months (range 4.7-60.9 months), with four patients lost to follow-up. Six patients (6.3%) developed local recurrence (two with isolated local recurrence and four with local and distant recurrence). Twelve patients (12.8%) experienced distant recurrence. The 5-year OS and DFS rates were 84.3% and 76.2%, respectively. Possible prognostic factors for local recurrence (including distal tumour level <= 5 cm, clinical nodal stage, clinical threatened margin, pathological stage, harvested lymph nodes <12, distal margin <1 cm, positive extramural venous invasion, and circumferential resection margin) were evaluated by multivariable logistic regression, and were shown to be insignificant. Conclusion Upfront laparoscopic TME for MRI-selected rectal cancer patients can achieve favourable oncological outcomes in our centre. Routine neoadjuvant treatment for all T3 or nodal positive disease is not necessary.