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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
Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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

Keywords

Laparoscopic intersphincteric resection Rectal cancer Prospective multicenter study 

Notes

Acknowledgments

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

Disclosures

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.

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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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