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Transperineal minimally invasive abdominoperineal resection for low rectal cancer: standardized technique and clinical outcomes

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A Correction to this article was published on 02 September 2021

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Abstract

Background

Despite the increasing utilization of transanal total mesorectal excision as a promising approach for low rectal cancer, the feasibility and safety of transperineal minimally invasive abdominoperineal resection (tp-APR) remain unclear.

Methods

In total, 25 patients who underwent tp-APR between April 2017 and May 2020 (tp-APR group) and 27 patients who underwent conventional laparoscopic APR between May 2009 and September 2016 (lap-APR group) for low rectal cancer were enrolled in this retrospective study. Clinical outcomes were compared between the groups before and after propensity score matching. The primary outcome was the incidence of the overall postoperative complications with Clavien–Dindo grade II or above. Standardized technique of tp-APR was also demonstrated.

Results

On comparison, operative time, intraoperative blood loss, and overall postoperative complications with Clavien–Dindo grade II or above were significantly less in the tp-APR group both before and after propensity score matching. The rates of urinary disturbance and perineal wound infection were significantly less in the tp-APR group after matching. Further, postoperative hospital stay was significantly shorter in the tp-APR group both before and after matching. However, pathological outcomes did not differ between the groups before and after matching. There has been no local recurrence in the tp-APR group with a median follow-up period of 18 months.

Conclusion

Standardized tp-APR for low rectal cancer is feasible and seems superior to conventional laparoscopic APR in terms of short-term outcomes. Further larger-scale studies with a longer follow-up period are required to evaluate oncological outcomes.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Kimihiro Yamashita, Hiroshi Hasegawa, Gosuke Takiguchi, Naoki Urakawa, Masashi Yamamoto, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki & Yoshihiro Kakeji

  2. Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan

    Takeru Matsuda

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  1. Takeru Matsuda
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Correspondence to Takeru Matsuda.

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Takeru Matsuda, Kimihiro Yamashita, Hiroshi Hasegawa, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.

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Matsuda, T., Yamashita, K., Hasegawa, H. et al. Transperineal minimally invasive abdominoperineal resection for low rectal cancer: standardized technique and clinical outcomes. Surg Endosc 35, 7236–7245 (2021). https://doi.org/10.1007/s00464-021-08633-5

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