Laparoscopic Abdominal Transanal Proctocolectomy with Coloanal Anastomosis Is a Good Surgical Option in Selective Patients with Low-Lying Rectal Cancer: A Retrospective Analysis Based on a Single Surgeon's Experience.

Abstract

We intended to identify the oncological outcome for rectal cancer over the past 20 years and whether or not sphincter-preserving surgery is an appropriate approach for low-lying rectal cancer. The oncological outcomes from a total of 418 patients who electively underwent rectal cancer surgery for a lesion located within 8 cm of the anal verge by a single colorectal surgeon were reviewed retrospectively. Of 418 patients, 175 patients underwent low anterior resection (LAR), 172 laparoscopic abdominal transanal proctocolectomy with coloanal anastomosis (LATA), and 71 abdominoperineal resection (APR). The factors related to the disease-free survival (DFS) were neoadjuvant chemoradiation (P = .016), pathologic stage (P < .001), circumferential margin involvement (P < .001), and initial (P = .016) and postoperative serum carcinoembryonic antigen level (P < .001). The factors related to the overall survival (OS) were similar with those related to DFS. Compared with DFS, OS, and local recurrence among three surgical techniques, APR was significantly poorer in DFS (P < .001), OS (P < .001), and local recurrence (P = .001), than was LAR or LATA. The LATA procedure is a technically feasible and oncologically safe surgical option for low-lying rectal cancer. We suggest that LATA may be a good surgical option in selective low-lying rectal cancer patients.