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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

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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.

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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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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Centre, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan

    Shoichi Fujii

  2. Division of Colorectal Surgery, National Cancer Centre Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Seiichiro Yamamoto

  3. Colorectal Surgery Division, National Cancer Centre Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Masaaki Ito

  4. Department of Gastroenterological Surgery, Saitama Medical University International Medical Centre, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Shigeki Yamaguchi

  5. Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Kazuhiro Sakamoto

  6. Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Yusuke Kinugasa

  7. Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kmikyo-ku, Kyoto, 602-8566, Japan

    Yukihito Kokuba

  8. Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan

    Junji Okuda

  9. Translational Research Centre, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Kenichi Yoshimura

  10. Department of Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555, Japan

    Masahiko Watanabe

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  1. Shoichi Fujii
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  2. Seiichiro Yamamoto
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  3. Masaaki Ito
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  6. Yusuke Kinugasa
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  7. Yukihito Kokuba
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  8. Junji Okuda
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  10. Masahiko Watanabe
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Corresponding author

Correspondence to Shoichi Fujii.

Additional information

This study is conducted on behalf of the Japan Society of Laparoscopic Colorectal Surgery.

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Fujii, S., Yamamoto, S., Ito, M. et al. 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. Surg Endosc 26, 3067–3076 (2012). https://doi.org/10.1007/s00464-012-2317-1

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  • DOI: https://doi.org/10.1007/s00464-012-2317-1

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