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Laparoscopicvs. open abdominoperineal resection for cancer

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Diseases of the Colon & Rectum

Abstract

PURPOSE: The aim of this study was to compare the safety and efficacy of laparoscopic abdominoperineal resection and open abdominoperineal resection for cancer. METHODS: Records of 194 patients who underwent laparoscopic abdominoperineal resection (42 patients) or open abdominoperineal resection (152 patients) at three institutions between 1991 and 1997 were reviewed. Follow-up was through office charts, American College of Surgeons cancer registry, or telephone contact. Tumors included (laparoscopic abdominoperineal resection and open abdominoperineal resection, respectively) adenocarcinoma (86 and 92 percent), squamous (12 and 7 percent), and gastrointestinal stromal (2 and 1.4 percent) types; Stages I (17 and 26 percent), II (24 and 33 percent), III (43 and 32 percent), and IV (14 and 9 percent); and those with invasion of pelvic structures (14 and 16 percent). RESULTS: Laparoscopic abdominoperineal resection was converted to open abdominoperineal resection in 21 percent because of vessel injury (33 percent), poor exposure (22 percent), adhesions (22 percent), inguinal hernia (11 percent), or radiation fibrosis (11 percent). Perineal infections occurred more often in the laparoscopic abdominoperineal resection group (24vs. 8 percent;P=0.02). Late stoma complications were similar. Mean hospital stay was shorter after laparoscopic abdominoperineal resection (7vs. 12 days). Radial margins were positive in 12 percent of laparoscopic abdominoperineal resection and 12.5 percent of open abdominoperineal resection specimens. Tumor recurrence was similar for both local (19 and 14 percent) and distant (38 and 26 percent) recurrence. Survival rates were similar by Kaplan-Meier curves, with median follow-up of 19 and 24 months, respectively (P=0.22; log rank). CONCLUSION: Laparoscopic abdominoperineal resection can be performed safely and results in a shorter hospital stay. A randomized, prospective trial is needed to determine the long-term outcome of cancer treatment.

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Authors and Affiliations

  1. From the Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri

    James W. Fleshman M.D., Elisa H. Birnbaum M.D., Ira J. Kodner M.D. & Thomas E. Read M.D.

  2. the Department of Colorectal Surgery, Cleveland Clinic Foundation and Health Sciences Center of Ohio State University, Ft. Lauderdale, Florida

    Steven D. Wexner M.D., Jean-Francois LaTulippe M.D., Juan J. Nogueras M.D. & Eric G. Weiss M.D.

  3. Department of Surgery, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada

    Mehran Anvari Ph.D, M.D.

Authors
  1. James W. Fleshman M.D.
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  2. Steven D. Wexner M.D.
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  3. Mehran Anvari Ph.D, M.D.
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  4. Jean-Francois LaTulippe M.D.
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  5. Elisa H. Birnbaum M.D.
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  6. Ira J. Kodner M.D.
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  7. Thomas E. Read M.D.
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  8. Juan J. Nogueras M.D.
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  9. Eric G. Weiss M.D.
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Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, Texas, May 2 to 7, 1998.

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Fleshman, J.W., Wexner, S.D., Anvari, M. et al. Laparoscopicvs. open abdominoperineal resection for cancer. Dis Colon Rectum 42, 930–939 (1999). https://doi.org/10.1007/BF02237105

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  • DOI: https://doi.org/10.1007/BF02237105

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