Laparoscopic Abdominoperineal Resection for Lower Rectal Malignancy in National Taiwan University Hospital: Eight-Year Experience

Abstract

Purpose. Laparoscopic abdominoperineal resection (APR) has been used in the management of lower rectal cancer. The purpose of this study was to assess our experience in laparoscopic APR at National Taiwan University Hospital.Methods. Between January 2003 and November 2011, 37 patients who were diagnosed as lower rectal malignancy and who underwent laparoscopic APR were enrolled in this study. Lower rectal malignancy was defined as the cancer located within 6cm above the anal verge. Laparoscopic resection was based on the following oncological principles: en bloc resection with high ligation of inferior mesenteric vessels, no-touch isolation and total mesorectal excision.Results. Laparoscopic APR was successfully performed in all patients without conversion. There were 16 male and 21 female patients with an average age of 61.5±13.6 years (range: 30-85 years). The pathological TNM staging was distributed as following: stage I in 9 patients, stage II in 12 patients, stage III in 13 patients, and stage IV in 3 patients. The mean operation time was 298.3±77.3 minutes. All the patients experienced a quick recovery except one patient had perineal abscess formation requiring surgical debridement. There was no intraoperative complication. By the Clavien-Dindo complication classification, there were grade I complication in 2 patients, grade II in 6 patients, and grade III in 1 patient. One patient developed local recurrence, and 12 patients developed distant metastases. The estimated 3-year survival rate was 82.17%.Conclusions. Laparoscopic APR was a safe and feasible procedure for lower rectal malignancy. Following the surgical principle of laparoscopic APR ensured satisfactory oncological outcomes.