Incisionless laparoscopic excision of low rectal carcinoma

Abstract

Objective To study the feasibility and curative effect of ineisionless laparoscopic total mesorectal excision of low rectal carcinoma in which an abdominoperineal resection was conducted without an accessory incision for the removal of the tumor containing bowel segment.Methods From January 2002 to January 2005,69 low rectal carcinoma (＜ 7 cm from the anal verge) patients undergoing incisionless laparoscopic total mesorectal excision (study group) ,in comparison with 68 patients receiving traditional laparoseopic assisted total mesorectal excision(control group).The operative procedures,clinicopathological data and short-term outcomes were compared.Results All the patients accepted laparoscopic operation successfully.The operating time in control group and study group was (150±25) min versus (130±22) min (t = 4.97,P ＜ 0.05),the hospital fee was (17900 ± 850) RMB yuan versus (9900±750) RMB yuan (t =58.43,P＜0.05),the length of abdomen incision was (5 ± 1.5) cm versus 0 cm (t = 27.69,P ＜ 0.05),the blood loss was (75± 26) ml versus (77 ±23) nd(t = 0.47,P ＞ 0.05),the number of lymph node dissected was (11.5±2.3) versus (12.1 ±1.6) (t =1.77,P＞0.05),the resected specimen length was (15.5 ± 3.2) cm versus (15.8 ± 3.5) cm (t = 0.52,P ＞ 0.05),the negative distal margin was (2.5 ±0.6) cm versus (2.6 ± 0.5) cm (t = 1.06,P ＞ 0.05),the time of bowel function recovery was (48 ±2.3) h versus (48 ±3.1) h (t =0.00,P ＞0.05) and the use of analgetics was 88% versus 86% (X~2 =0.05,P ＞0.05).All the patients were followed-up from 45 months to 79 months (average 59.9 months).The 1-,3-year recurrent rate and survival rate were 0,3% and 99% ,96% in study group,and those in the control group were 0,1% and 97%,96% respectively,with the difference being not significant (X~2 = 0.00,0.32,0.35,0.15,P ＞ 0.05).Patients in both group all regained satisfactory bowel continence 9 months after operation.Conclusions Incisionless laparoscopic total mesorectal excision with anal preservation is in line with oncologic principle,and a safe and feasible approach to the surgical treatment of lower rectal cancer,with the advantage of shorter operation time,shorter hospital fee and more cosmetic. Key words: Laparoscopy; Rectal neoplasms; Total mesorectal excision