Clinical efficacy of different approaches for laparoscopic intersphincteric resection of low rectal cancer: a comparison study

Wenquan Ou,Yuanfeng Yang,Guoxian Guan,Xing Liu,Yiyi Zhang,Jinfu Zhuang,Xiaohua Wu

doi:10.1186/s12957-022-02521-5

Abstract

BackgroundThe operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach.MethodsWe retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n = 142), the transabdominal perineal approach for ISR (TPAISR, n = 57), or the transanal pull-through approach for ISR (PAISR, n = 36).ResultsThe PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, 3-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups.ConclusionsTAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.

Highlights

The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported
The proportion of patients with a luminal circumference of the tumor (LCIT) > 50% was significantly smaller in the pull‐through approach for ISR (PAISR) group (27.8%) than in the Transabdominal perineal approach for ISR (TPAISR) group (63.2%) (P = 0.001)
In conclusion, LAISR (TAISR, TPAISR, and PAISR) of the three different approaches are all optional surgical methods, each with its own advantages, and there is no significant difference in surgical safety, tumor outcome, and anal function

Summary

Introduction

The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. Most of these reports have involved dissection of the intersphincteric space based on the laparoscopic TME technique, which is followed by transection of the rectum through the perineum at a safe distance from the distal edge of the tumor under direct vision, and handsewn repair [9, 11, 12] This operative approach is complicated and technically difficult, because separation of the anterior rectal wall can damage the vagina in women (the urethra and prostate may be damaged in men), and many postoperative complications and severe anal functional damage have been noted [3, 4]. The premise of all three of these laparoscopic ISR approaches is to separate the intersphincteric space based on laparoscope-assisted TME in order to ensure negative circumferential and distal margins, which is the crucial and most difficult step of laparoscopic ISR

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