Viet Trung Lam, MD, PhD. Cho Ray hospital, Ho Chi Minh City, Vietnam
Overview: Rectal cancer is one of popular cancers of digestive tract. With low rectal cancer which located <5cm from anal verge, the traditional method of surgery is abdominoperineal resection in which total anus and sphincter were resected and permanent colostomy. Recent studies have shown favorable outcomes of sphincter saving surgery with laparoscopic approach for low rectal cancer.
Aim: To evaluate the feasibility and results of laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis for low rectal cancer. Method: Prospective study. From 4/2009 to 6/2017 we performed laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in 25 patients with low rectal cancer about 1-4 cm from dentate line with no sphincter involvement.
Results: Mean operation time was 270 minutes. No intraoperative complications. Postoperative complications was 12% (3/25) included 2 cases had late anastomotic leak (8%) which were re-operated on. There was no mortality. Anastomotic stenosis happened in 1 case (4%) which was treated conservatively with anal dilatation. With the follow-up time 34.8 months (4-101 months), most of patients had stool 6 – 10 times/day in the first 1-3 months which was gradually less frequently to 1 -3 times / day in the following 3 months. There was no local recurrence. One case with distal metastasis (liver and lung) treated with chemotherapy and targeted therapy is still in good health. One patient died at 20 months due to liver and peritoneal metastasis.
Conclusion: Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis is feasible, safe and effective in functional and oncological results with selected patients. Less pain, early recovery, lower cost for not using staplers besides preserving sphincter function are those of its advantages. It is needed to have longer follow-up time to evaluate the long-term functional and oncologic outcomes.
Key words: Intersphincteric resection, coloanal anastomosis, low rectal cancer
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93929
Program Number: P374
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster