Safety of Laparoscopic Proctectomy for Rectal Cancer

Shigeki Yamaguchi, MD, Jo Tashiro, MD, Toshimasa Ishii, MD, Tomonori Hosonuma, MD, Takahiro Sato, MD, Mistuo Miyazawa, MD, Nozomi Shinozuka, MD. Saitama Medical University International Medical Center

Purpose: Laparoscopic magnification is great advantage for precise surgery. In this study, complications were assessed after laparoscopic rectal cancer resection, especially autonomic nerve injury.
Patients: Consecutive 128 laparoscopic proctectomy by single surgeon were enrolled since 2007 April to 2010 August. Mean age was 65.0 year-old, 85 males and 43 females were included. Procedures were; anterior resection 24, low anterior resection 72 (with diversion 25), intersphincteric resection 22, Hartmann 8, and APR 2.
Results: Mean operating time and blood loss count were 259 minutes and 44g, respectively. Median postoperative hospital stay was 10 days. Postoperative complications were; urinary dysfunction 6 (4.7%), ileus 3 (2.3%), and wound infection 3 (2.3%). Anastomotic complications were; leakage 14 (11.8% of anastomosis cases) and bleeding 4. In 6 patients of urinary dysfunction, 2 patients were caused by BPH. Transient self-catheterization was needed in 3 patients for one week to 4 months. Catheterization is still necessary in one patient for 6 weeks after proctectomy. Intraoperative autonomic nerve resection was performed in 3 patients because of large cancer and severe adhesion. Autonomic nerves were incidentally injured in 4 patients of which were; pelvic plexus 2, pervic nerve 1, hypogastric nerve 1. There was no dysuria in those injured patients because the damage was incomplete and unilateral.
Conclusion: After laparoscopic proctectomy, anastomotic leakage is most serious complication. Nerve injury is relatively rare and urinary dysfunction is also rare.