Long term efficacy of laparoscopic intersphincteric resection as sphincter preserving surgery for ultra-low rectal cancer

Abstract

Objective To evaluate the long term outcome and feasibility of laparoscopic intersphincteric resection (ISR) as a way of the sphincter preserving surgery to treat ultra-low rectal carcinoma. Methods From January 2009 to June 2011, thirty-eight patients with ultra-low rectal cancer (less than 5 cm from the anal verge) received laparoscopic ISR (laparoscopic group), while 32 patients with similar conditions received laparotomy (open group) in the Second Affiliated Hospital of Shantou University Medical College. The function of anal sphincter was evaluated at 1, 3, 6, 12 and 24 months after operation. The operation condition, long-term survival and outcome were compared between the two groups. Results Compared with the open group, the laparoscopic group had less bleeding and shorter hospital stay (U=4.992, t=4.608, all P<0.001). After follow-up of 72 (61-96) months, there were 6 cases (15.8%) of local recurrence and 3 cases (7.9%) of distant metastasis in the laparoscopic group, 5 cases (15.6%) had local recurrence and 2 cases (6.3%) had distant metastasis in the open group. There were no significant differences in the local recurrence rate and distant metastasis rate between the two groups (χ2=0.096, 0.071; P=0.985, 0.790). The incidence of distant metastasis was significantly higher in patients with lymph node metastasis (χ2=6.412, P=0.011). The rate of 5-year overall survival (OS) and disease-free survival (DFS) in the laparoscopic group were 84.2% and 81.6%, and those of open group were 81.3% and 78.1%, respectively. There were no significant differences in 5-year OS and DFS between the two groups (χ2=4.167, 1.776; P=0.794, 0.768). The 5-year DFS of laparoscopic group with stage III patients was significantly lower than that with stage I and II patients (χ2=0.107, 0.130; P=0.028, 0.041). With the progress of recovery and rehabilitation, patients in both groups experienced similar improvement in defecation (P=0.413). Conclusion With a satisfactory long term outcome, ISR, as a means of the sphincter preserving surgery, is a feasible, minimal invasive and reasonable option for ultra-low rectal carcinoma. Key words: Rectal neoplasms; Sphincterotomy, endoscopic; Treatment outcome; Anal preservation