Objective: The aim of this study was to clarify the short-term results of laparoscopic intersphincteric resection (LAPISR) for very low rectal cancer.
Methods: A total of 24 consecutive resections between October 2003 and March 2009 were included in this study. Our indications for LAPISR were tumor edge 5 cm above the anal verge or 3 cm above the dentate line with clinical stage1. We evaluated intra- or post-operative clinical results, and described the merits of LAPISR.
Results: Mean age was 59. Mean length between anal verge and tumor lower edge was 4.5cm. Average operative time was 351min and blood loss was 350ml. Intersphincter was totally removed in 4 patients and partially preserved in 20 patients. All reconstructions were made by straight colo-anal anastomosis. Diverting stoma was reconstructed in 16 and no stoma in 8. No patients underwent conversion from laparoscopic to open surgery. Curative resection and anal preservation was performed in all patients. No mortality was found and postoperative anastomotic leakage occurred in 3(13 percent) of the 24 patients. Stoma closure was completed in all patients. No recurrences were found in median follow-up term of 22 months. Postoperative continence was preserved in most of patients with a mean Wexner score of 8. We could see the puborectal muscle and hiatal ligament surrounding the rectum at the bottom of the pelvis clearly in laparoscopic surgery compared with open surgery, which lead an accurate intersphincteric dissection in the anal canal.
Conclusion: The short-term results of LAPISR were clinically acceptable. We could Identified the anatomy of the deep pelvis which was essential to the appropriate ISR in laparoscopic surgery.
Program Number: P137