To assess feasibility, advantages, oncological safety, cost effectiveness and long term results of laparoscopic surgery for rectal cancer in a government sector hospital.

From January 2005 to May 2007, 20 patients of operable cancer rectum were subjected to laparoscopic curative resection. Surgical technique, postoperative morbidity and clinical results were reviewed in close follow-up for median period of 20 months (12 wks to 30 months).

Fourteen patients underwent LAPR and 6 patients LAR.

Median age was 39 years. Median operating time for Lap APR was 296 minutes, initial 7 cases taking an average of 368 minutes, while subsequent 7 cases average operating time was 232.5 minutes. In Lap AR, average duration of surgery was 356 minutes, first 4 cases taking 400 minutes while for last 2 cases, and mean operating time was 300 min.

There was no intraoperative complication in either group. All patients mobilized on POD: (1) Incidence of PONV was significantly less. Oral feeds were routinely started on POD, (2) Incidence of wound infection was also reduced (2/20). Hospital stay on an average was 11 days as ours being a government sector hospital, patients were discharged only after drain removal and thus stay was slightly prolonged. Of the 20 patients, 17 were diagnosed to be Adenocarcinoma, 2 with Malignant Melanoma and 1 with GIST. Two patients of malignant melanoma developed locoregional recurrence and 2 patients developed distant metastasis after approximately 1 year. No incidence of port metastasis in any patient.

Laparoscopic colorectal surgery is safe, feasible and meets oncologic requirements of radicality. Pattern of local recurrence and distant metastasis is similar to open surgery. Lap surgery has a steeper learning curve. Cost of treatment decreased by use of Ligaclips for intracorporeal vascular control and extracorporeal division of gut whenever possible.