Abstract
Background
Traditionally, conventional intersphincteric resection requires a combined abdominal and perineal approach and a handsewn coloanal anastomosis procedure, which is difficult to accomplish via the perineal approach. A completely abdominal approach partial intersphincteric resection (APISR) with laparoscopy can simplify the anastomosis procedure. This study evaluated the intermediate-term oncological and functional results of laparoscopic versus open APISR for low rectal cancer.
Methods
A total of 137 consecutive patients with low rectal cancer who underwent APISR from January 2006 to August 2013 were retrospectively evaluated. Patient groups were classified into as open surgery (OP, n = 48) group and laparoscopy (LAP, n = 89). The primary endpoint was 3-year disease-free survival and the Wexner score for anal function.
Results
The LAP group had longer operating time, less intraoperative blood loss, and shorter hospital stay after surgery compared with the OP group. Median follow-up was 32.3 months. The local recurrence rates were similar in the two groups (LAP 3.2 % vs. OP 6.1 %; P = 0.652). The combined 3-year disease-free survival rate was 83.2 % in the LAP group and 83.8 % in the OP group (P = 0.857). Wexner scores were similar in the two groups (LAP 2.9 ± 4.5 vs. OP 3.1 ± 5.0). In the LAP group, 89.7 % of patients had good continence compared with 91.4 % in the OP group (P = 0.311).
Conclusions
Laparoscopic APISR can be performed safely and offers similar intermediate-term oncological and functional outcome compared with the open procedure. The oncological adequacy requires long-term follow-up data.
Similar content being viewed by others
References
Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376–8.
Braun J, Treutner KH, Winkeltau G, et al. Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma. Am J Surg. 1992;163:407–12.
Rullier E, Zerbib F, Laurent C, et al. Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum. 1999;42:1168–75.
Bretagnol F, Rullier E, Laurent C, et al. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum. 2004;47:832–8.
Ng SS, Leung KL, Lee JF, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 2008;15:2418–25.
Li S, Chi P, Lin H, et al. Long-term outcomes of laparoscopic surgery versus open resection for middle and lower rectal cancer: an NTCLES study. Surg Endosc. 2011;25:3175-82.
Green BL, Marshall HC, Collinson F, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg. 2013;100:75–82.
Rullier E, Sa Cunha A, Couderc P, et al. Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg. 2003;90:445–51.
Fujimoto Y, Akiyoshi T, Kuroyanagi H, et al. Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg. 2010;14:645–50.
Park JS, Choi GS, Jun SH, et al. Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg. 2011;254:941–6.
Laurent C, Paumet T, Leblanc F, et al. Intersphincteric resection for low rectal cancer: laparoscopic versus open surgery approach. Colorectal Dis. 2012;14:35–41.
Chi P, Lin HM, Lu XR, et al. Laparoscopic pelvic approach to ISR for ULAR. Chinese J Practical Surg. 2010;30:203–5. Available: http://en.cnki.com.cn/Article_en/CJFDTOTAL-ZGWK 201003020.htm.
Hamada M, Matsumura T, Matsumoto T, et al. Video. Advantages of the laparoscopic approach for intersphincteric resection. Surg Endosc. 2011;25:1661–3.
Park SY, Choi GS, Park JS. Short-term clinical outcome of robot-assisted intersphincteric resection for low rectal cancer: a retrospective comparison with conventional laparoscopy. Surg Endosc. 2013;27:48–55.
Park SY, Choi GS, Park JS, et al. Robotic-assisted transabdominal intersphincteric resection: a technique involving a completely abdominal approach and coloanal anastomosis. Surg Laparosc Endosc Percutan Tech. 2013;23:e5–10.
Chi P, Chen ZF, Lin HM, et al. Laparoscopic extralevator abdominoperineal resection for rectal carcinoma with transabdominal levator transection. Ann Surg Oncol. 2013;20:1560–6.
Denost Q, Laurent C, Capdepont M, et al. Risk factors for fecal incontinence after intersphincteric resection for rectal cancer. Dis Colon Rectum. 2011;54:963–8.
Hohenberger W, Merkel S, Matzel K, et al. The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis. 2006;8:23–33.
Portier G, Ghouti L, Kirzin S, et al. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg. 2007;94:341–5.
Chamlou R, Parc Y, Simon T, et al. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg. 2007;246:916–21. Discussion 921–2.
Yamada K, Ogata S, Saiki Y, et al. Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2009;52:1065–71.
Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg. 2009;249:236–42.
Watanabe M, Teramoto T, Hasegawa H, et al. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum. 2000;43:s94–7.
Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today. 2013;43:838–47.
Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg. 2012;99:603–12.
Han JG, Wei GH, Gao ZG, et al. Intersphincteric resection with direct coloanal anastomosis for ultralow rectal cancer: the experience of People’s Republic of China. Dis Colon Rectum. 2009;52:950–7.
Bartlett L, Sloots K, Nowak M, et al. Biofeedback for fecal incontinence: a randomized study comparing exercise regimens. Dis Colon Rectum. 2011;54:846–56.
Cong JC, Chen CS, Ma MX, et al. Laparoscopic intersphincteric resection for low rectal cancer: stapled and manual coloanal anastomosis compared. Colorectal Dis. 2014;16:353–8.
Acknowledgment
This study was supported by National Clinical Key Specialty Construction Project (General Surgery) of China (No. 2012-649).
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Chi, P., Huang, SH., Lin, HM. et al. Laparoscopic Transabdominal Approach Partial Intersphincteric Resection for Low Rectal Cancer: Surgical Feasibility and Intermediate-Term Outcome. Ann Surg Oncol 22, 944–951 (2015). https://doi.org/10.1245/s10434-014-4085-8
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-014-4085-8