Purpose: Laparoscopic proctectomy is still controversial, especially for lower rectal cancer. This study assessed laparoscopic proctectomy for extraperitoneal rectal cancer.
Patients: Thirty four consecutive laparoscopic proctectomy for extraperitoneal rectal cancer were enrolled since 2002 to 2008. Mean age was 64.4 year-old, they were 21 males and 13 females. Procedures were; low anterior resection (LAR) with stapling anastomosis: 20, intersphincteric resection (ISR): 13, Hartmann: 1. Lymph node dissection was; D3 (from origin of the IMA): 12, D2 (from LCA): 22. Preoperative diagnosis was; T1: 22, T2: 9, T3: 3. There were no case with preoperative radiation therapy. Diverting stoma was made in 11/13 of ISR and in 8/20 of LAR.
Technique: Regarding very low anterior resection and ISR, intersphinteric space was opened by laparoscopic approach. Generally anorectal ring is well-confirmed and dissected easily. This technique is very useful for ISR to diminish the anal work near cancer. Also for very low anterior resection, linear stapling is easier after intersphincteric mobilization.
Results: Mean operating time was 327 minutes. According to procedures, operating time of LAR was 316 min. and that of ISR was 354 min. Mean blood loss was 119g in overall, 104g in LAR and 143g in ISR. No patients needed blood transfusion. Median postoperative hospital stay was 10 days in overall, 9 days in LAR and 11 days in ISR. There were two leakages in LAR (10%).and no leakage in ISR. Postoperative ileus was seen in each one case of both LAR and ISR. Urinary dysfunction with transient self-catheterization was also seen in one case each. There was no mortality. One local recurrence was detected in T3 patients.
Conclusion: Laparoscopic proctectomy for lower rectal cancer is feasible and safe in T1 and T2 patients.
Program Number: P172