Transanal Versus Transabdominal Specimen Extraction With Laparoscopic Low Anterior Resection: A Comparative Analysis On 432 Patients With Rectal Cancer

Song Liang, MD PHD, Morris E Franklin, Jr, MD FACS. The Texas Endosurgery Institute

BACKGOUND AND OBJECTIVES: This prospective comparison study focused on the patients with rectal cancer who underwent either transanal or transabominal specimen extraction after laparoscopic low anterior resection with total mesorectal excision and was specifically aimed at investigating if the transanal approach can be accepted as a safe and effective method for extracting the malignant specimen from peritoneal cavity.

METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal malignancy with various TMN classifications between April 1991 to May 2011 at the Texas Endosurgery Institute was analyzed, and all the statistical calculations were performed with SPSS.

RESULTS: A total of 432 patients underwent laparoscopic low anterior resection (LLAR) with total mesorectal excision (TME) during this study period. Transabdominal specimen extraction was applied to 256 patients for delivering specimens out of the peritoneal cavity after the laparoscopic procedure while 179 patients experienced transanal specimen extraction. In comparison on perioperative data, transanal group did not show significant difference from transabdominal arm on age (67yo vs 69yo; p= 0.12), operative time (180.9+/-43.5 minutes vs 198.3+/-43.5 munites; p= 0.07), estimated blood loss (126.6+/-73.6 ml vs 172.2 +/- 144 ml, p= 0.82), intraoperative complications (1.1% vs 0.8%; p= 0.69), postoperative complications (2.8% vs 4.2%, p=0.59), and hospital stay (6.9 +/- 2.8 days vs 9.1 +/- 3.7 days; p= 0.83). During long-term follow-up, 9 out of 179 patients who underwent LLAR/TME with transanal specimen extraction were confirmed to have malignant recurrence with 2-year local recurrence rate of 5.0%, which did not statistically differ from that of transabdominal group (2.3%, p= 0.15).

CONCLUSIONS: Transanal specimen extraction in laparoscopic rectal cancer resection is a safe and effective approach with comparable recurrence rate of cancer and postoperative complication rates, thus it can be integrated into laparoscopic low anterior resection as an alternative approach to extract the malignant specimen(s) from the abdominal cavity.