Laparoscopic Intersphincteric Resection for Low Rectal Cancer

Sang Woo Lim, MD PhD, Chang Hyun Kim, MD, Hun Jin Kim, MD, Jung Wook Huh, MD PhD, Young Jin Kim, MD PhD, Hyeong Rok Kim, MD PhD. Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital


INTRODUCTION : The aim of current study is to compare the outcomes of laparoscopic intersphincteric resection (ISR) with laparoscopic abdominoperineal resection (APR) in patients with low rectal cancer.
METHODS AND PROCEDURES: From July 2004 to December 2009, patients with rectal cancer below 6 cm from anal verge treated by laparoscopic curative intersphincteric resection and abdominoperineal resection were included in a retrospective comparative study. Neoadjuvant chemoradiation was given to patients with T3-4 or N+ tumors. Recurrence and survival were evaluated by the Kaplan Meier methods and compared using the Log rank test.
RESULTS: Laparoscopic intersphincteric resection was performed in 124 patients with low rectal cancer, and 55 patients were performed laparoscopic abdominoperineal resection. The median follow up period was 31.2 months (range, 2-75). Demographic data of age (60.2 vs. 61.3years, p=0.58), body mass index (kg/m2, 23.6 vs. 22.7, p=0.17), ASA score (p=0.87), tumor stage (p=0.11) were similar in laparoscopic ISR and APR group. Tumor location is lower (3.9 vs. 2.3 cm, p=0.04), and tumor size were larger (2.7 vs. 3.3cm, p=0.02) in APR group. Preoperative chemoradiation were performed in 114 patients (91.9%) in laparoscopic ISR group and 19 patients (34.5%) in APR group (p=0.00). Operation time was longer in ISR group (227.6 vs. 183.4 min, p=0.01). Conversion to open surgery was found in 2 ISR and 1 APR (p=0.37). Distal resection margin was 2.1 cm in ISR and 3.1 cm in APR (p=0.02). Harvested lymph nodes were similar in both group (13.6 vs. 13.9, p=0.94). Postoperative morbidity and hospital stay were similar in both groups. The survival rate of ISR was higher than APR in 3-year overall survival (90.1% vs. 75.9%, p=0.021), and 3-year disease-free survival (72.5% vs. 56.7%, p=0.062). The recurrence rate was lower in ISR group in overall recurrence (14.6% vs. 29.1%, p=0.006), systemic recurrence (15.4% vs. 32.7%, p=0.001), and local recurrence (4.9% vs. 12.7%, p=0.030).
CONCLUSIONS: Sphincter preservation in low rectal cancer can be facilitated by laparoscopic intersphincteric resection after preoperative chemoradiation.

Session Number: Poster – Poster Presentations
Program Number: P101
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