Feasibility and functional outcome of laparoscopic intersphincteric rectal resection for ultra-low rectal cancer

Abstract

The Aim of this study is to evaluate the feasibility and analyze the functional outcome of laparoscopic intersphincteric resection (LISR) in ultra-low rectal cancer. The preservation of anal function following curative operations for low rectal cancer is becoming increasingly important. Laparoscopic intersphincteric resection of the rectum is the utmost sphincter saving operation for rectal cancer. The rectum is laparoscopically resected along with the internal anal sphincter, providing an adequate distal margin for even the ultra-low tumours of the rectum. Between 2008 and 2012, nine patients, 2 with a T3 tumour that received preoperative chemoradiotherapy and 7 patients with a non-fixed T2 rectal adenocarcinoma, underwent LISR by a single surgeon. Preoperative tumour staging included endorectal ultrasonography (ERUS) and pelvic MRI. Patients with multiple distant metastases, tumour invasion into adjacent organs and invasion into the external anal sphincter and/or levator ani, were excluded from LISR. Covering ileostomy in seven patients was reversed with a satisfactory functional outcome in each case. All patients underwent LISR with curative intent. There was no postoperative mortality. Complications included anal stenosis, prolapse of the neorectum and pelvic hematoma. The overall quality of life and functional outcome were deemed satisfactory. In selected patients, intersphincteric rectal resection may provide an acceptable functional outcome for ultra-low rectal cancer patients, without a permanent stoma.