Laparoscopic Abdominoperineal Resection for Low Rectal Adenocarcinoma

Abstract

Purpose. Laparoscopic abdominoperineal resection (LAPR) is an accepted alternative to open resection for treating patients with low rectal adenocarcinoma, but the long term results are seldom reported. The purpose of our study was to evaluate the long term outcome in low rectal adenocarcinoma patients treated with laparoscopic abdominoperineal resection. Methods. We reviewed our experience with 35 patients who underwent laparoscopic abdominoperineal resection for low rectal adenocarcinoma at Changhua Christian Hospital between 1999 and 2003, and another 31 low rectal adenocarcinoma patients who accepted open abdominoperineal resection during the same period of time was compared. The patient's short term outcome, such as bowel function recovery time, duration of hospital stays and long term oncological result were recorded and analyzed. The option for conversion rate, laparoscopic operation time and complication were also discussed. Results. Of 66 total patients, 31 were in the open group and 35 were in the laparoscopic group; 4 (11%) of the latter were converted to open surgery. The overall complication rate in this study is 24.24% and there was no operative mortality in the study. No port-site metastasis was found in laparoscopic group, and no surgical wound metastasis was found in open group. No statistically significant difference in body weight, height, BMI, anesthesia score, pre-operative chemoradiotherapy, cancer stage, survival time, and mean operative time was found among the 3 groups. Blood loss for open surgery and completed laparoscopic resection were (mean±SD) 619±355.4 mL vs 325±292.7 mL(p=0.001). The time that bowel function resumed, time to ingestion of water, and time to resumption of solid foods between the open and laparoscopic groups were (mean ± SD) 2.5±0.6 vs 2±0.8 days (p=0.032), 2±0.8 vs 1.5±0.6 days (p=0.015), and 3.7±0.9 vs 3.2±0.9 days, respectively (p＜0.005). The over all survival rates at 5 years were 65.72% in open group and 69.40% in laparoscopic group (p=0.7723).There are four local recurrent (6.06%) in the study. Distal metastasis at 5 years follow-up was noted in 14 patients and located at liver, lung and adrenal gland. Conclusion. Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique for the treatment of patients with low rectal adenocarcinoma.