Surgical Endoscopy

, Volume 26, Issue 11, pp 3067–3076 | Cite as

Short-term outcomes of laparoscopic intersphincteric resection from a phase II trial to evaluate laparoscopic surgery for stage 0/I rectal cancer: Japan Society of Laparoscopic Colorectal Surgery Lap RC

  • Shoichi Fujii
  • Seiichiro Yamamoto
  • Masaaki Ito
  • Shigeki Yamaguchi
  • Kazuhiro Sakamoto
  • Yusuke Kinugasa
  • Yukihito Kokuba
  • Junji Okuda
  • Kenichi Yoshimura
  • Masahiko Watanabe



Laparoscopic intersphincteric resection (Lap ISR) is not yet an established technique and its safety and feasibility are unclear. Our aim was to clarify the safety and feasibility of Lap ISR for clinical stage 0/I rectal cancer (Lap RC) in a prospective multicenter study of laparoscopic surgery in Japan.


To examine the technical and oncological feasibility of laparoscopic surgery for rectal cancer, we conducted a confirmatory phase II trial to evaluate laparoscopic surgery for preoperative clinical stage 0/I rectal cancer. Eligibility criteria included histologically proven carcinoma, size ≤ 8 cm, age 20–75 years, no bowel obstruction, and no prior chemotherapy or radiotherapy. Between February 2008 and September 2010, 495 patients with rectal cancer underwent laparoscopic surgery at 43 institutions. Patients’ background characteristics and operative and postoperative outcomes were recorded prospectively.


Seventy-seven patients (15.6 %) underwent Lap ISR. A diverting stoma was created in 69 patients (89.6 %). Conversion to open surgery occurred in 4 patients (5.2 %): 2 patients were converted because of uncontrollable bleeding, and the other 2 patients because of the need for pelvic side wall lymphadenectomy. There was no mortality. Median operative time was 345 min (range = 198–565), median amount of blood loss was 100 ml (range = 0–1760), and three patients (3.9 %) were transfused intraoperatively. The median number of dissected lymph nodes was 14 (range = 3–33), and all (proximal, distal, and vertical) pathological cut margins were negative. Postoperative complications of grade 2 or more were detected in 17 patients (22.1 %), including anastomotic leakage in 5 (6.4 %), bowel obstruction in 5 (6.5 %), and surgical site infection in 2 (2.6 %). Abdominal drainage and diverting stoma were necessary in two patients (2.6 %) due to anastomotic leakage. Median length of postoperative hospital stay was 13 days (range = 7–167).


Lap ISR was feasible and safe for clinical stage 0/I rectal cancer with favorable short-term outcome.


Laparoscopic intersphincteric resection Rectal cancer Prospective multicenter study 



Lap RC was funded by the Japanese Society for Cancer of the Colon and Rectum.


Shoichi Fujii, Seiichiro Yamamoto, Masaaki Ito, Shigeki Yamaguchi, Kazuhiro Sakamoto, Yusuke Kinugasa, Yukihito Kokuba, Junji Okuda, Kenichi Yoshimura, and Masahiko Watanabe have no conflicts of interest or financial ties to disclose.


  1. 1.
    Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766PubMedCrossRefGoogle Scholar
  2. 2.
    Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopic-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  3. 3.
    Leung KL, Kwok SPY, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomized trial. Lancet 363:1187–1192PubMedCrossRefGoogle Scholar
  4. 4.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison laparoscopic assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  5. 5.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of randomized trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645PubMedCrossRefGoogle Scholar
  6. 6.
    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM, For the MRC CLASICC Trial Group (2005) Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial); multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  7. 7.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  8. 8.
    Row D, Weiser MR (2010) An update on laparoscopic resection for rectal cancer. Cancer Control 17:16–24PubMedGoogle Scholar
  9. 9.
    Miyajima N, Fukunaga M, Hasegawa H, Tanaka J, Okuda J, Watanabe M (2009) Results of a multicenter study of 1,057 cases of rectal cancer treated by laparoscopic surgery. Surg Endosc 23:113–118PubMedCrossRefGoogle Scholar
  10. 10.
    Yamamoto S, Yoshimura K, Konishi F, Watanabe M (2008) Phase II trial to evaluate laparoscopic surgery for stage 0/I rectal carcinoma. Jpn J Clin Oncol 38:497–500PubMedCrossRefGoogle Scholar
  11. 11.
    Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F (2005) Sphincter-saving resection for all rectal carcinoma: the end of the 2-cm distal rule. Ann Surg 241:465–469PubMedCrossRefGoogle Scholar
  12. 12.
    Schiessel R, Novi G, Holzer B, Rosen HR, Renner K, Hölbling N, Fei W, Urban M (2005) Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 48:1858–1865PubMedCrossRefGoogle Scholar
  13. 13.
    Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246:916–921PubMedCrossRefGoogle Scholar
  14. 14.
    Akasu T, Takawa M, Yamamoto S, Fujita S, Moriya Y (2007) Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma. J Am Coll Surg 205:642–647PubMedCrossRefGoogle Scholar
  15. 15.
    Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F (2007) Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg 94:341–345PubMedCrossRefGoogle Scholar
  16. 16.
    Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y, Yoneyama Y, Nishizawa Y, Minagawa N (2009) Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg 33:1750–1756PubMedCrossRefGoogle Scholar
  17. 17.
    Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M (2009) Long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum 52:1065–1071PubMedCrossRefGoogle Scholar
  18. 18.
    Kuo LJ, Hung CS, Wu CH, Wang W, Tam KW, Liang HH, Chang YJ, Wei PL (2011) Oncological and functional outcomes of intersphincteric resection for low rectal cancer. J Surg Res 170:e93–e98PubMedCrossRefGoogle Scholar
  19. 19.
    Watanabe M, Teramoto T, Hasegawa H, Kitajima M (2000) Laparoscopic ultralow anterior resection combined with per anus intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum 43:S94–S97PubMedCrossRefGoogle Scholar
  20. 20.
    Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5:451–453PubMedCrossRefGoogle Scholar
  21. 21.
    Rullier E, Sa CA, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90:445–451PubMedCrossRefGoogle Scholar
  22. 22.
    Orsenigo E, Palo SD, Vignali A, Staudacher C (2007) Laparoscopic intersphincteric resection for low rectal cancer. Surg Oncol 16:S117–S120PubMedCrossRefGoogle Scholar
  23. 23.
    Fujimoto Y, Akiyoshi T, Kuroyanagi H, Konishi T, Ueno M, Oya M, Yamaguchi T (2010) Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 14:645–650PubMedCrossRefGoogle Scholar
  24. 24.
    Yamamoto S, Fujita S, Akasu T, Inada R, Takawa M, Moriya Y (2011) Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach. Dig Surg 28:404–409PubMedCrossRefGoogle Scholar
  25. 25.
    Lim SW, Huh JW, Kim YJ, Kim HR (2011) Laparoscopic intersphincteric resection for low rectal cancer. World J Surg 35:2811–2817PubMedCrossRefGoogle Scholar
  26. 26.
    Hamada M, Matsumura T, Matsumoto T, Teraishi F, Ozaki K, Nakamura T, Fukui Y, Nishioka Y, Taniki T, Horimi T (2011) Video. Advantages of the laparoscopic approach for intersphincteric resection. Surg Endosc 25:1661–1663PubMedCrossRefGoogle Scholar
  27. 27.
    Laurent C, Paumet T, Leblanc F, Denost Q, Rullier E (2012) Intersphincteric resection for low rectal cancer: laparoscopic vs open surgery approach. Colorectal Dis 14:35–41PubMedCrossRefGoogle Scholar
  28. 28.
    Colorectal Cancer Society (2006) The 7th Edition of the Japanese General Rules for Clinical and Pathological Studies on Cancer of the Colon, Rectum and Anus. Kanahara Publications, Tokyo in JapaneseGoogle Scholar
  29. 29.
    Eastern Cooperative Oncology Group (1999) Common Toxicity Criteria, version 2.0. Available at
  30. 30.
    National Cancer Institute. Common Terminology Criteria for Adverse Events version 3.0. Available at
  31. 31.
    International Union Against Cancer (2002) TNM classification of malignant tumours, 6th edn. Wiley-Liss, New YorkGoogle Scholar
  32. 32.
    Japan Society for Endoscopic Surgery (2010) 10th nationwide survey of endoscopic surgery in Japan. J Jpn Soc Endosc Surg 15:565–679 in JapaneseGoogle Scholar
  33. 33.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Shoichi Fujii
    • 1
  • Seiichiro Yamamoto
    • 2
  • Masaaki Ito
    • 3
  • Shigeki Yamaguchi
    • 4
  • Kazuhiro Sakamoto
    • 5
  • Yusuke Kinugasa
    • 6
  • Yukihito Kokuba
    • 7
  • Junji Okuda
    • 8
  • Kenichi Yoshimura
    • 9
  • Masahiko Watanabe
    • 10
  1. 1.Department of SurgeryGastroenterological Centre, Yokohama City UniversityYokohamaJapan
  2. 2.Division of Colorectal SurgeryNational Cancer Centre HospitalTokyoJapan
  3. 3.Colorectal Surgery DivisionNational Cancer Centre Hospital EastChibaJapan
  4. 4.Department of Gastroenterological SurgerySaitama Medical University International Medical CentreSaitamaJapan
  5. 5.Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
  6. 6.Division of Colon and Rectal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
  7. 7.Department of SurgeryKyoto Prefectural University of MedicineKyotoJapan
  8. 8.Department of General and Gastroenterological SurgeryOsaka Medical CollegeOsakaJapan
  9. 9.Translational Research Centre, Kyoto University HospitalKyotoJapan
  10. 10.Department of SurgeryKitasato University HospitalKanagawaJapan

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