MASAAKI ITO, MD PhD, NORIO SAITO, MD PhD, YUSUKE NISHIZAWA, MD PhD, MASANORI SUGITO, MD PhD, AKIHIRO KOBAYASHI, MD PhD. National Cancer Center Hospital East
Objective: The aim of this study was to compare the short-term results and postoperative functional outcomes between laparoscopic intersphincteric resection (Lap ISR) and open intersphincteric resection (Open ISR) for very low rectal cancer.
Methods: We performed a case controlled pair-matched study comparing 48 patients who had undergone either Lap ISR or Open ISR. Our former report showed that three significant clinical factors, such as male, total resection of the internal anal sphincter and performance of preoperative chemoradiotherapy (CRT), were associated with poor anal function after ISR. Therefore patients in this study were matched by the factors. Our indications for ISR were tumor edge 5 cm above the anal verge or 3 cm above the dentate line, and Lap ISR was performed for the patients with rectal cancer of clinical stage1. We compared intra- or post-operative clinical results, and postoperative urinary or anal functions between two groups.
Results: There were no statistically significant differences in clinical backgrounds such as age, gender, tumor site, preoperative CRT and extent of excision of the anal sphincter muscle among two groups. Median operative time was 326 min in Lap ISR group and 328 min in Open ISR group. Blood loss in Lap ISR was less than one in open ISR, and the difference was statistically significant ( 350ml vs 911ml, p<0.01). We had no postoperative reoperation in both groups. The rates of anastomotic leakage were found in 13% of both groups. R0 operation was achieved in all patients in both groups. Urinary dysfunction as early complications after ISR was found 4% in Lap ISR and 21% in Open ISR (p=0.08). Fecal incontinence score was 7 points in Lap ISR and 11 points in Open ISR, and the difference was statistically significant (p=0.03).
Conclusion: We could see the anatomical structures at the bottom of the pelvis clearly by using laparoscope when performing the intersphincteric dissection. The advantage lead the superiority in postoperative anal function in patients who had been performed by Lap ISR compared with open procedures.
Program Number: S030