Masaaki Ito, Yuji Nishizawa, Takeshi Sasaki, Yuichiro Tsukada. National Cancer Center Hospital East
Objective: The aim of this study was to clarify oncological results of laparoscopic intersphincteric resection (ISR) for very low rectal cancer near the anus.
Methods: We began laparoscopic ISR for very low rectal cancer locating below 5cm from the anus since 2003. Our initial indication of laparoscopic ISR was primary rectal cancer with c-stage I and we then expanded it to c-stage II or III from 2011, for which we additionally performed lateral lymph node dissection (LLND) under laparoscope. We have experienced total of 100 patients of laparoscopic ISR completing at least 3-years follow-ups and evaluated the oncological results of them.
Results: The current clinical series included 60 male and 40 female with average age of 61 years old. The average distance from the tumor to the anal verge was 4.5cm. There were 76 TME procedures for patients with c-stage I and 24 procedures of TME plus LLND for patients with stage II or more. We performed partial ISR in 51, subtotal ISR in 29 and total ISR in 20 patients, respectively and partial resection of the external anal sphincter was added in 12 patients. Operative time in TME group was 368 min and one in TME plus LLND group was 469 min. All the patients were curatively treated without tumor exposure at CRM. Postoperative anastomotic leakage with grade I, II, and III of Clavien-Dindo classification was found in 3, 3 and 13 patients. Ninety-four patients had received closure of ileostomy and 2 patients of the rest could not done due to recto-vaginal fistula and mucosal prolapse. 3-years recurrence rate and 3-year local recurrence rate were found in 9% and 4% of p-stage I, 20% and 20% of p-stage II and 40% and 10% of p-stage III and IV. There experienced 7 local recurrences totally, but in which more than 1mm of CRM were achieved in them and sites of the local recurrence were mainly seen in lateral cavity.
Conclusion: Laparoscopic ISR was feasible for stage I rectal cancer near the anus. For stage II or III rectal cancer, additional preoperative therapies might be needed to reduce the risks of their local recurrences.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79962
Program Number: P229
Presentation Session: Poster (Non CME)
Presentation Type: Poster