Long-term Results of Laparoscopic Intersphincteric Resection with Quadrant Resection of Upper External Sphincter in Cases of the Very Low Rectal Cancer

Seung Hyun Baek, MD, NahmGUN Oh, Phd. Pusan National University Hospital

Purpose: Laparoscopic interspincteric resection is an increasing optional surgical tool in the treatment of very low rectal cancer below 4cm from anal verge. This study is designed to evaluate the long-term oncological and functional outscomes of laparoscopic  intersphincteric resection for T2 and T3 rectal cancer situated below 4cm from the anal verge.

Methods: From 2000 to 2010, A total of 62 consecutive patients with low rectal cancer underwent curative laparoscopic intersphincteric resection.  After preoperative radio-chemotherapy, patients with overt T2 lesion were 24 cases and received traditional laparoscopic intersphincteric resection (Group I:  standard laparoscopic intersphincteric resection), and patients with borderline cases or T3 lesion were 38 cases and received extended laparoscopic  intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter(Group II: extended laparoscopic  intersphincteric resection).

Results: The grade I, II of continence by Kirwan’s classification was 91.7%, 86.8% in Group I and II and the mean Wexner score were 3.2±, 3.8± in Group I and II. The five-year overall survival rate was 94 percent, and the five-year disease-free survival rate was 86 percent. There were no postoperative mortality.

Conclusions: This extended laparoscopic intersphinteric resection with quadrant resection of upper external sphincter is able to obtain good post-operative continence status , OS and DFS. This extended laparoscopic  intersphincteric resection can be alternative to laparoscopic abdominoperineal resection for very low rectal cancer without compromising chance of cure and can improve quality of life.