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Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience

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Summary

Background

Intersphincteric resection (ISR) with hand-sewn coloanal anastomosis (CAA) has been proposed as an alternative to abdominoperineal resection (APR) for low rectal cancer. However, there is still lack of evidence regarding long-term outcomes of this procedure. Therefore, the aim of this study is to evaluate the feasibility, safety, and long-term results of this surgery.

Methods

This is a prospective study conducted from 2009–2019. Patients with low rectal cancer lying in 3–5 cm from the anal verge graded as T1–T3 were included. Laparoscopic ISR and hand-sewn CAA with inverted ileostomy were performed in all patients. Perioperative and long-term functional and oncological outcomes were investigated.

Results

There were 39 patients (25 men and 14 women) with the mean age of 54.5 years. The mean operating time and postoperative hospital stay were 196 ± 18 min and 7.1 ± 0.7 days. No complication or mortality occurred within 30 days postoperatively. Three late complications occurred: two anastomotic leakages and one anastomotic stricture. Mean follow-up duration was 45.6 months. There was no recurrence and most patients were satisfied with the preserved anus (mean Wexner incontinence score was 6.4 and 3.1 at 6 and 12 months, respectively). Three individuals (7.7%) had distant metastasis and two died. The disease-free survival and overall survival probabilities were 90.8% and 91.6% at 5 years.

Conclusion

Laparoscopic ISR with hand-sewn CAA is feasible, safe and has good long-term outcomes for low rectal cancer and might be a good alternative to APR. More studies are required to better improve long-term outcomes of this surgery.

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Author information

Authors and Affiliations

  1. Digestive Surgery Department, Cho Ray hospital, 201B Nguyen Chi Thanh, Ward 12, District 5, Ho Chi Minh City, Viet Nam

    Lam Viet Trung, Tran Vu Duc, Nguyen Vo Vinh Loc & Tran Phung Dung Tien

  2. Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Viet Nam

    Lam Viet Trung, Nguyen Vo Vinh Loc, Tran Phung Dung Tien & Nguyen Lam Vuong

  3. Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Viet Nam

    Nguyen Lam Vuong

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  1. Lam Viet Trung
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  4. Tran Phung Dung Tien
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by Lam Viet Trung, Tran Vu Duc, Nguyen Vo Vinh Loc and Tran Phung Dung Tien. Data analysis was performed by Lam Viet Trung and Nguyen Lam Vuong. The first draft of the manuscript was written by Lam Viet Trung and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nguyen Lam Vuong.

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Conflict of interest

L. V. Trung, T. V. Duc, N. V. V. Loc, T. P. D. Tien and N. L. Vuong declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

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Trung, L.V., Duc, T.V., Loc, N.V.V. et al. Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience. Eur Surg 53, 222–230 (2021). https://doi.org/10.1007/s10353-021-00694-z

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