Early Outcome of Laparoscopic Abdomino-Perineal Resection (Apr) in Low Rectal and Anal Cancer

Abstract

Background: Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma in the lower part of the rectum involving anal canal especially sphincter or purely in the anal canal is now successfully managed by laparoscopic APR and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in oncologic clearance. The advantages of laparoscopic surgery are smaller incisions, shorter recovery time and less wound related complications. However the narrow confines and angulations of the bony pelvis and the standard practice of autonomic nerve sparing total mesorectum excision has made laparoscopic surgery in the setting of rectal cancer more challenging. Methods: This randomized controlled trial study was carried out in the Colorectal Surgery Unit, Department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 25 patients were treated by conventional open APR and rest 25 patients were treated by laparoscopic APR. All Patients of two groups were selected by simple random method (lottery). Early outcome variables after surgery were evaluated. Results: During early post-operative follow up, abdominal surgical site infection was found more in conventional open APR patients than that of laparoscopic APR patients (p<0.05). Other morbidity and colostomy related complications were not significant in early post-operative period in both groups of population. Degree of pain was also less after laparoscopic APR. Only stoma function occurred earlier after Laparoscopic APR and ambulation, feeding liquid and feeding solid all had no difference for both group. Shorter mean length of postoperative total hospital stay and early hospital discharge was possible after Laparoscopic APR. Oncologic parameters were equivalent to those of open procedures. Conclusion: The patients undergoing laparoscopic APR surgery had overall superior outcomes in term of surgical site infection, postoperative pain, postoperative total hospital stay and had equivalent oncologic clearance than those of open procedures in low rectal and anal cancer.mesorectum excision