Open Abdominoperineal Resection Research Articles

P-047 PERINEAL HERNIA: RECTUS ABDOMINIS MUSCLE FLAP REPAIR

Abstract Aim Perineal hernia (PH) is a rare complication of pelvic surgeries. We present two cases of male patients with symptomatic PH following abdominoperineal resection (APR), repaired with rectus abdominis muscle flap. Cases presentation N1: 66-year male, 1 year after laparoscopic-assisted APR was treated with rectus abdominis muscle flap repair (RAM) by open abdominal approach. In postoperative period, heavy bronchitis leaded to the disruption of the muscle flap and need of reoperation. The patient healed completely two months after the repair. No recurrence of PH within 5 years has been registered. N2: 64-year male, underwent chemoradiotherapy and open APR for rectal carcinoma. 2 years later, CT showed a PH and 2cm wide mass suspicious of cancer recurrence in pelvis. By the open abdominal – perineal approach, the mass of recurrence was excised, and PH was repaired with vertical rectus abdominis muscle flap (VRAM). The postoperative period was uneventful and 1 year after the surgery, the patient is cancer and PH free. Discussion Treatment of more advanced carcinomas or wide use of radiotherapy can lead to an increased number of PH. Abdominal, perineal or combined approaches exists. The pelvic floor reconstruction is mostly realized by mesh implantation or flap repair. In our presented cases, we took advantage of long existing cooperation with plastic surgeon team and chose rectus abdominis muscle flap reconstruction. We proved its feasibility and good effect on PH repair. Conclusion Perineal hernia repair is challenging. No consensus regarding the ideal method exists. Every case must be assessed individually.

Operative Approach Does Not Impact Radial Margin Positivity in Distal Rectal Cancer

Robotic surgery is attractive for resection of low rectal cancer due to greater dexterity and visualization, but its benefit is poorly understood. We aimed to determine if operative approach impacts radial margin positivity (RMP) and postoperative outcomes among patients undergoing abdominoperineal resection (APR). This was a retrospective cohort study of patients from the National Surgical Quality Improvement Program who underwent APR for low rectal cancer from 2016 to 2019. Patients were stratified by operative approach: robotic, laparoscopic, and open APR (R-APR, L-APR, and O-APR). Emergent cases were excluded. The primary outcome was RMP. 30-day postoperative outcomes were also evaluated, using logistic regression analysis. Among 1,807 patients, 452 (25.0%) underwent R-APR, 474 (26.2%) L-APR, and 881 (48.8%) O-APR. No differences regarding RMP (13.5% R-APR vs. 10.8% L-APR vs. 12.3% O-APR, p = 0.44), distal margin positivity, positive nodes, readmission, or operative time were observed between operative approaches. Adjusted analysis confirmed that operative approach did not predict RMP (p > 0.05 for all). Risk factors for RMP included American Society of Anesthesiologists (ASA) classification III (ASA I-II ref; OR 1.46, p = 0.039), pT3-4 stage (T0-2 ref, OR 4.02, p < 0.001), pN2 stage (OR 1.98, p = 0.004), disseminated cancer (OR 1.90, p = 0.002), and lack of preoperative radiation (OR 1.98, p < 0.01). No difference in RMP was observed among R-APR, L-APR, and O-APR. Postoperatively, R-APR yielded greater benefit when compared to O-APR, but was comparable to that of L-APR. Minimally invasive surgery may be an appropriate option and worthy consideration for patients with distal rectal cancer requiring APR.

PD30-06 RATES OF NEWLY DIAGNOSED ERECTILE DYSFUNCTION AFTER SURGERY FOR COLORECTAL CANCER

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (PD30)1 Sep 2021PD30-06 RATES OF NEWLY DIAGNOSED ERECTILE DYSFUNCTION AFTER SURGERY FOR COLORECTAL CANCER Christopher Gaffney, Nahid Punjani, Aaron Brant, Jonathan Fainberg, Xinyan Zheng, Art Sedrakyan, and James Kashanian Christopher GaffneyChristopher Gaffney More articles by this author , Nahid PunjaniNahid Punjani More articles by this author , Aaron BrantAaron Brant More articles by this author , Jonathan FainbergJonathan Fainberg More articles by this author , Xinyan ZhengXinyan Zheng More articles by this author , Art SedrakyanArt Sedrakyan More articles by this author , and James KashanianJames Kashanian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002031.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Abdominoperineal resection (APR) and low anterior resection (LAR) for colorectal cancer (CRC) are associated with high rates of erectile dysfunction (ED) in case series that may be underdiagnosed in practice. We sought to explore rates of new diagnoses of ED after both minimally invasive (MIS) and open LAR, APR and hemicolectomy. METHODS: The Surveillance, Epidemiology, and End Results–Medicare database was used to record new diagnoses of ED after an index procedure (MIS or open LAR, APR or hemicolectomy) for CRC. The primary outcome was a new diagnosis of ED within 2 years of the index procedure. Men aged >66 years with any index procedure within 1 year of diagnosis of CRC were included. Men with a history of ED, metastatic CRC or prostate or bladder cancer prior to their index procedure were excluded. We performed a Cox proportional hazard model adjusting for baseline demographic factors, procedure group, procedure type (MIS versus open), Charlson comorbidity index, tumor stage and grade, history of chemoradiation therapy, and socioeconomic status through 2 years of follow up. RESULTS: Of 60, 648 men diagnosed with CRC between 2004-2015, 28,387 met inclusion criteria. 21,650 (76.4%) men were treated with hemicolectomy, 4,814 (17.0%) with LAR, and 1,883 (8.7%) with APR. On multivariable analysis, the hazard ratio (HR) for a new diagnosis of ED was 1.28 (95%CI 1.08 to 1.51) for LAR and 1.46 (95%CI 1.12-1.90) for APR compared to hemicolectomy. Other factors associated with a diagnosis of ED were black race (HR 2.01, 95%CI 1.63-2.48), geography (Southern compared to Northeast region) (HR 1.20 95%CI 1.08-1.57), and MIS (HR 1.43, 95%CI 1.25-1.65). Kaplan Meyer analysis detailing the increased rate of ED diagnoses in patients treated with APR and LAR as compared to hemicolectomy is seen in Figure 1. CONCLUSIONS: Compared to hemicolectomy, men treated with LAR and APR and men treated with MIS as compared to open surgery have higher rates of new ED diagnoses within 2 years of treatment. The absolute rate of ED diagnoses was low compared to prior carefully annotated case series, suggesting that patients are frequently underdiagnosed. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e534-e534 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Gaffney More articles by this author Nahid Punjani More articles by this author Aaron Brant More articles by this author Jonathan Fainberg More articles by this author Xinyan Zheng More articles by this author Art Sedrakyan More articles by this author James Kashanian More articles by this author Expand All Advertisement Loading ...

Epidural dexmedetomidine infusion in a patient with chronic opioid use and intractable pain following abdominoperineal resection.

Dexmedetomidine is a selective alpha 2 adrenergic agonist with known analgesic properties. Its perioperative use is associated with reduced pain scores and an opioid sparing effect. Management of postoperative pain in patients with a history of chronic opioid use can be challenging. Multimodal analgesia is recommended although the perioperative use of dexmedetomidine has not been extensively studied in this patient population. We present a case of intractable abdominal pain following open abdominoperineal resection in a patient with rectal cancer and a history of chronic opioid use. Following the introduction of dexmedetomidine into the patient’s postoperative epidural solution, a noticeable decline in reported pain scores and use of breakthrough analgesia was appreciated. The analgesic efficacy of epidural dexmedetomidine in patients with a history of chronic opioid use warrants further study.

Early Outcome of Laparoscopic Abdomino-perineal Resection (APR) in Low Rectal and Anal Cancer- Our Initial Experience in Bangabandhu Sheikh Mujib Medical University

Background: Colorectal cancer is the second most common malignancy in the western countries and the rectum is the most frequent site involved. Carcinoma of the lower part of the rectum involving the anal canal and carcinoma of the anal canal are now successfully managed by laparoscopic abdomino-perineal resection (APR) and postoperative morbidities are less and recovery is uneventful. In the current age of minimally invasive surgery, laparoscopic surgery for colon cancer has been established as equivalent to conventional open surgery in terms of oncological clearance. The purpose of the study is to compare the early outcomes of laparoscopic abdomino-perineal resection (LAPR) surgery in low rectal and anal cancer patients in terms of surgical site infections, postoperative pain, recovery, hospital stay and margin clearance of tumor with that of open abdomino-perineal resection (OAPR) surgery.&#x0D; Methods: This randomized controlled trial was carried out in the Colorectal Surgery Unit of Bangabandhu Sheikh Mujib Medical University, Dhaka from May, 2012 to April, 2013. 50 patients in low rectal and anal canal cancers were randomized into two groups with 25 patients in conventional open abdomino-perineal resection (OAPR) and rest 25 patients in laparoscopic abdomino-perineal resection (LAPR). Early outcome variables after surgery were evaluated.&#x0D; Results: Demographic data and baseline characteristics are equivalent in both groups of population. Tumors were more common in rectum (80% and 76%), most of the tumors were adenocarcinomas (80% and 72%) and most of the tumors were present in stage-II (40% and 48%) with grade-2 (64% and 52%) in LAPR and OAPR groups respectively. During early post-operative follow up, abdominal surgical site infection was found more in conventional open abdomino-perineal resection (OAPR) patients than that of laparoscopic abdomino-perineal resection (LAPR) patients (p =0.001). Other morbidity and colostomy related complications were not significant in early post-operative period in both groups of population. Degree of pain was also less after laparoscopic abdomino-perineal resection (p=0.001 ). Stoma function occurred earlier after Laparoscopic abdomino-perineal resection (p =0.017) and ambulation, feeding liquid and feeding solid all had no difference for both groups. Shorter mean length of postoperative hospital stay and early hospital discharge was possible after Laparoscopic abdomino-perineal resection (p =0.001 ). Oncologic parameters were equivalent to those with open procedures.&#x0D; Conclusion: The patients undergoing laparoscopic APR for low rectal and anal canal carcinoma have overall superior outcomes in terms of surgical site infection, postoperative pain, postoperative hospital stay and has equivalent oncological clearance as with those with open procedures.&#x0D; Journal of Surgical Sciences (2014) Vol. 18 (2) : 57-61

Evaluation of Male Sexual Dysfunction Associated with Laparoscopic versus Open Resection in Rectal Cancer in Different Age Groups

Background and goals Sexual dysfunction is a well-documented complication of rectal cancer surgery, with a reported incidence of 18% - 59%. The objective of this study is to evaluate the incidence of sexual dysfunction (SD) in males after radical resection for rectal cancer and to compare the outcome of open versus laparoscopic rectal resection for different age groups. Patients and methods This prospective randomized study assessed outcomes in male patients that underwent rectal resection for rectal cancer from January 2012 until March 2015 at two large tertiary hospitals in Cairo, Egypt. The patients were randomly allocated into two groups (laparoscopic and open technique) of 40 patients each using the odd number policy for patient allocation. Patients included in each group were further subdivided into two groups according to the type of rectal resection either anterior resection (AR) or abdominoperineal resection (APR). Erectile function was evaluated preoperatively and postoperatively at 3 and 6 months using the International Index of Erectile Function (IIEF) questionnaire. Results There was no significant difference between the laparoscopic and open total mesorectal excision (TME) groups when comparing IIEF score preoperatively. At 3 months postoperatively, the laparoscopic arm showed better results over the open arm (abnormal IIEF in 57.5% vs. 67.5%). The study demonstrated dramatic improvement in SD in both groups at 6 months postoperatively (abnormal IIEF score of 40% in the laparoscopic vs. 42.5% in the open arm) with no significant difference in IIEF score between the two groups (p-value 0.876). At 3 and 6 months postoperatively, younger patients showed significant improvement in SD compared to older patients in both groups with more significant improvement in the laparoscopic group (16.7% vs. 40%). Patients with APR show more SD compared with AR patients whether laparoscopic or open as seen by the abnormal IIEF scores for the the two groups [the laparoscopic group APR patients showed 62.5% abnormal IIEF at 3 months that decreased to 50% after 6 months compared to 56.3% and 37.5% at 3 and 6 months respectively for lap. AR patients, and in the open group APR patients also showed higher abnormal IIEF of 71.4% and improved to 42.9% at 3 and 6 months respectively compared to 66.7% and 42.3% at 3 and 6 months respectively for open AR), which shows that APR whether laparoscopic or open causes more sexual dysfunction than AR. Conclusion In this randomized prospective study, there was no significant difference between the laparoscopic and open TME when we compared IIEF scores. In patients younger than 30 years, the significant improvement in the laparoscopic arm adds to the favorable outcome of laparoscopic TME as regards postoperative complications, postoperative pain, hospital stay, the return of bowel functions and cosmetic results.

Parastomal and incisional hernia following laparoscopic/open abdominoperineal resection: is there a real difference?

The aim of the present study was to explore incidence and severity of parastomal hernia (PSH) formation during the first 2years after open/laparoscopic abdominoperineal resection (APR). This was a retrospective cohort study conducted in a single institution. All patients who underwent laparoscopic/open APR for low rectal cancer within a 10-year study period were assessed for study eligibility. In total, 148 patients were included in the study (97 patients after laparoscopic APR; 51 patients after open APR). There were no statistically significant differences between study subgroups regarding demographic and clinical features. The incidence of PSH detected by physical examination was significantly higher in patients after laparoscopic APR 1year after the surgery (50.5% vs. 19.6%, p < 0.001) and 2years after the surgery (57.7% vs. 29.4%, p = 0.001). The incidence of radiologically detected PSH was significantly higher in laparoscopically operated patients after 1year (58.7% vs. 35.3%, p = 0.007) and after 2years (61.8% vs. 37.2%, p = 0.004). The mean diameter of PSH was similar in both study subgroups. The incidence of incisional hernia was significantly higher in patients who underwent open APR after 1year (25.5% vs. 7.2%, p = 0.002) and after 2years (31.3% vs. 7.2%, p < 0.001). The risk of PSH development after laparoscopic APR appears to be significantly higher in comparison with patients undergoing open APR. Higher incidence of PSH should be considered a potential disadvantage of minimally invasive approach to patients with low rectal cancer.

Comparative analysis of robot-assisted vs. open abdominoperineal resection in terms of operative and initial oncological outcomes

PurposeThe present study aimed to objectively evaluate robot-assisted abdominoperineal resection (APR) in comparison with open APR, in terms of operative elements and initial oncological outcomes.MethodsA total of 118 patients with lower rectal adenocarcinoma who had undergone curative APR were consecutively enrolled between June 2010 and June 2016, i.e., robot-assisted group (n = 40) and open group (n = 78).ResultsTransabdominal extralevator muscle excision was more frequently performed in the robot-assisted group than in the open group (68% vs. 42%, P = 0.012). In the robot-assisted group, the pain score at one day after surgery was less than in the open group, and the resumption of bowel function was earlier (P = 0.043 and P = 0.002, respectively). The occurrence of circumferential resection margin involvement (CRM+) was more than 5 times greater in the open group than in the robot-assisted group, presenting a marginal significance (P = 0.057). Although important postoperative morbidity did not generally differ between the 2 groups, voiding difficulty and male sexual dysfunction appeared to be encountered more frequently in the open group than in the robot-assisted group.ConclusionThe robot-assisted APR facilitated transabdominal extralevator excision and bowel recovery and demonstrated a trend towards reduced CRM+.

482PD - Robot-assisted vs laparoscopic vs open abdominoperineal resections for low rectal cancer: Short-term outcomes of a single-center prospective randomized controlled trial

482PD - Robot-assisted vs laparoscopic vs open abdominoperineal resections for low rectal cancer: Short-term outcomes of a single-center prospective randomized controlled trial

Robotic vs. laparoscopic vs. open abdominoperineal resection for low rectal cancer: Short-term outcomes of a single-center prospective randomized controlled trial.

3603 Background: Currently, robotic surgery for rectal cancer using da Vinci System is common. However, there is almost no clinical trial reported. This randomized controlled trial aims to compare the safety and efficacy of robotic, laparoscopic and open abdominoperineal resection (APR) for low rectal cancer. Methods: From September 2013 to August 2016, patients aged from 18 to 75 years, with low rectal cancer within 5 cm from anal verge, clinical T1 to T3, no distant metastases, were randomly assigned to receive either robotic procedures (RAP), laparoscopic procedures (LAP) or open surgery (OS) for APR in 1:1:1 ratio. The primary endpoint was postoperative complication rate. This study is registered with ClinicalTrials.gov (NCT01985698). Results: Totally 406 patients were randomly assigned. Actually, 135 finished RAP, 131 finished LAP, and 137 finished OS (including 4 convert from LAP to OS). RAP had significantly lower postoperative complication rate (11.1%) than both LAP (21.4%, P = 0.023) and OS (27.7%, P = 0.001). Also, RAP reduced intraoperative hemorrhage (median [interquartile range], 100 [90-110] ml) than LAP (130 [100-150] ml, P &lt; 0.001) and OS (150 [120-260] ml, P &lt; 0.001). And RAP promoted postoperative recovery, with shorter days to first flatus (1.0 [1.0-2.0] day) than LAP (2.0 [2.0-3.0] day, P &lt; 0.001) and OS (3.0 [2.0-4.0] day, P &lt; 0.001), shorter days to first automatic urination (2.0 [2.0-3.0] day) than LAP (3.0 [2.0-4.0] day, P &lt; 0.001) and OS (3.0 [2.0-4.0] day, P &lt; 0.001), and shorter days to discharge (5.0 [5.0-6.0] days) than LAP (6.0 [5.0-7.0] days, P &lt; 0.001) and OS (6.0 [5.0-7.0] day, P = 0.005). There was no significant difference in open conversion rate, resection margin involvement (including circumferential resection margin), number of lymph node harvested and pathological tumor stage. Conclusions: Robotic APR was safer, and reproduce equivalent surgical quality of conventional laparoscopic and open surgery. Also, it provided less injury and faster functional recovery. Clinical trial information: NCT01985698.

A comparison of resection margins and lymph node clearance in laparoscopic vs open anterior and abdomino-perineal resections for carcinoma of rectum

Introduction: Laparoscopic anterior and abdomino-perineal resections for carcinoma rectum are associated with a lower morbidity than open surgery. It is important to evaluate laparoscopic resections against open surgery for tumour free resection margins and lymph node clearance. Methods: A retrospective analysis of resection margins and number of lymph nodes harvested at anterior and abdomino-perineal resections performed by laparoscopy and open surgery was done. Results: There was no statistically significant difference in the tumour free resection margins while lymph node clearance was significantly higher in the laparoscopy group. Conclusion: Laparoscopic surgery for carcinoma rectum provides a satisfactory oncological outcome with regards to clear resection margins and lymph node harvest.

Robot-Assisted vs Laparoscopic vs Open Abdominoperineal Resections for Low Rectal Cancer: Short-Term Outcomes of a Single-Center Randomized Controlled Trial

Robot-Assisted vs Laparoscopic vs Open Abdominoperineal Resections for Low Rectal Cancer: Short-Term Outcomes of a Single-Center Randomized Controlled Trial

A population-based comparison of open versus minimally invasive abdominoperineal resection

BackgroundAlthough minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate. MethodsA review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elective laparoscopic or open APR was conducted. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedure. ResultsWe identified 3,191 admissions meeting inclusion criteria (1,019 laparoscopic; 2,172 open). The conversion rate was 5%. Mortality was low and similar between groups (.88% vs .83%, P = .91). In-hospital complication rates were lower in the laparoscopic group (19% vs 29%, odds ratio .59, 95% confidence interval .49 to .71, P < .01), but conversion was associated with a higher rate (29% vs 18%, P < .01). Finally, a laparoscopic APR was associated with a shorter length of stay (5.3 vs 7.0 days, P < .01). ConclusionLaparoscopic APR is associated with improved outcomes and may be the preferred approach by surgeons with appropriate skills and experience.

Evaluating the Efficacy of Open Versus Laparoscopic Abdominoperianal Resection in Management of Patients with Low Rectal Cancer

Background: Abdominoperineal resection (APR) along with permanent colostomy is the standard method of low rectal cancer operation and resection. The laparoscopic APR provides better visualization of pelvic structures compared to the open approach. Disadvantages of the laparoscopic approach have been reported as longer operation duration and requirement of expensive equipment Although this issue has been investigated extensively worldwide, data is limited from Iran. Objectives: The aim of this study was to compare short-term outcome of Laparoscopic Abdominoperineal Resection (APR) with open APR in patients with low rectal cancer in Shiraz, southern Iran. Patients and Methods: This was a non-randomized controlled trial study performed in Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences from 2007 to 2012. We included all patients with rectal cancer who underwent laparoscopic or open APR with permanent colostomy. Both groups were evaluated regarding oncology results. Volume of intraoperative bleeding, short-term complications, operation to diet interval and duration of hospitalization were recorded and further compared between the laparoscopy and open APR groups. Results: Overall, 24 patients were included in this study of whom 11 underwent laparoscopy and 13 underwent open APR. The two study groups were comparable regarding age (P = 0.747), gender (P = 0.605), tumor stage (P = 0.116), tumor histopathology grade (P = 0.421) and distance from the anal verge (P = 0.711). The duration of operation was comparable between the groups (P = 0.336). Those who underwent laparoscopy had significantly lower intraoperative bleeding (485.5 ± 139.8 vs. 658.3 ± 183.2; P = 0.024), shorter operation-diet interval (2.27 ± 0.46 vs. 3.15 ± 0.37; P < 0.001) and shorter duration of hospitalization compared to the open APR group (4.09 ± 0.53 vs. 4.76 ± 0.59; P = 0.008). Conclusions: Laparoscopic APR is associated with minimal perioperative bleeding, shorter operation-diet interval and shorter durations of hospitalization compared to open approach in patients with low rectal cancer who had not received neoadjuvant chemo radiotherapy. Oncologic results in this operation were comprisable to open procedure because the mesorectal, anus and sphincter complex excision are performed in the same method. . Therefore, laparoscopy could be the method of choice for APR.

Early Outcome of Laparoscopic Abdominoperineal Resection, Our Experience in Bangabandhu Sheikh Mujib Medical University

Anorectal malignancies that require abdominoperineal resection (APR) is very common. Laparoscopic APR can be a better option. Laparoscopic APR has been seldom studied. This study aims to evaluate perioperative and early postoperative outcomes of laparoscopic APRs performed for the treatment of ano-rectal carcinomas. Patients operated for ano-rectal carcinoma between June 2011 to June 2013 in Bangabandhu Sheikh Mujib Medical University (BSMMU) were observed. Demographics, tumor and procedure-related parameters, perioperative results, early postoperative outcomes and survival were observed. Total 22 patients were under went laparoscopic APR. Male: Female ratio was 15:7 (68.18%: 31.82%). Age range was from 30-65 years with a mean age of 36.55 years. Mean operation time was 165 minutes and mean post-operative hospital stay was 6.8 days. Overall complication rate was 45.45%. Laparoscopic APR is a safe, effective and technically feasible procedure. It can be a better operative procedure than open APR. DOI: http://dx.doi.org/10.3329/fmcj.v8i2.20281 Faridpur Med. Coll. J. 2013;8(2): 53-55

Evaluation of short‐term outcomes after laparoscopically assisted abdominoperineal resection for low rectal cancer

To investigate the feasibility, safety and short-term efficacy of laparoscopic techniques applied in the abdominoperineal resection (APR) for low rectal cancer. The clinical data of 236 patients with APR from January 2010 to January 2012 were analysed retrospectively, including 100 patients underwent laparoscopically assisted APR (LAAPR group), 136 cases of open APR (OAPR group). The demographics, tumor and procedure-related parameters, perioperative results and short-term oncological outcomes were evaluated using t-test or χ(2) -test. The demographic data of the two groups were comparable. Perioperative results were better after laparoscopic surgery, with less intraoperative blood loss (P = 0.017), earlier return of bowel function (P < 0.05) and lower complication rates (P = 0.015). No significant differences were detected between the two groups in operation time, tumor size, specimen length, the distance of tumor from the anal verge, lymph nodes removed and the status of circumferential resection margin (P > 0.05). During the follow-up period of 17-38 months (average, 26 months), the overall survival rates were not significantly different between the two groups [82.5% (80/97) versus 82.7% (110/133), P > 0.05]. The differences in recurrence and metastasis between the two groups were not statistically significant. Laparoscopically assisted APR for low rectal cancer is safe and effective. It has the advantages of less bleeding, rapid postoperative recovery and fewer complications, without affecting the radical degree of the surgery. Further studies are needed to fully assess oncological outcomes in the future.

A case-matched comparison of the short-term outcomes between laparoscopic and open abdominoperineal resection for rectal cancer

The aim of this study was to evaluate the short-term surgical outcomes of laparoscopic abdominoperineal resection (APR) for rectal cancer, by comparing it with a case-control series of open APR. Fourteen patients with rectal cancer who underwent laparoscopic APR between August 2004 and November 2011 were compared with the open APR group of 14 patients matched for age, gender, and surgical procedure. There were no cases of conversion to laparotomy in the laparoscopic APR group and no mortality in either of the groups. The median operation was longer (P = 0.002), but the median amount of blood loss was smaller (P = 0.019), in the laparoscopic APR group. The median length of hospital stay of the laparoscopic APR group was 8 days, shorter than that of the open APR group (16 days, P < 0.001). The changes of the WBC count and serum CRP level after operations were significantly smaller in the laparoscopic APR group (P < 0.05). There were no significant differences between the groups in terms of the perioperative morbidity and readmission rates within 30 days. Patients undergoing laparoscopic APR had superior perioperative outcomes to those undergoing open APR, except for the longer operation.

A systematic review and meta‐analysis of randomized and non‐randomized studies comparing laparoscopic and open abdominoperineal resection for rectal cancer

Evidence supporting the role of laparoscopy in abdominoperineal resection (APR) is limited. This study compared the short-term and long-term outcomes and complications associated with open and laparoscopic APR. The Medline, Cochrane and Embase databases were searched for publications comparing open and laparoscopic APR. The rates of local and distant recurrence of rectal cancer were compared as the primary end-point. The occurrence of complications related to the two procedures was studied as the secondary end-point. The adequacy of cancer resection and postoperative recovery were also compared in a secondary analysis. Combined and separate analyses were performed for randomized and non-randomized studies. Eight publications comparing open and laparoscopic APR were identified. The rates of local and distant disease recurrence were lower after laparoscopic surgery compared with open APR (odds ratio 2.736 and 1.994, 95% confidence interval 1.137-6.584 and 1.062-3.742, P = 0.025 and P = 0.032, respectively). Early postoperative complications were fewer after laparoscopic APR (OR 2.159, 95% CI 1.426-3.269, P = 0.000). No significant benefit of either technique was observed in the secondary analysis. The long-term oncological benefits of laparoscopic APR are not convincingly superior to open surgery and need further validation. The laparoscopic approach is apparently associated with fewer postoperative complications, yet its role in improving the short-term outcomes is uncertain.

Surgical Outcomes of Laparoscopic Versus Open Abdominoperineal Resection for Anorectal Cancer: A Comparative Study

Introduction: There has been no large, randomized prospective trial and few retrospective studies to clarify the surgical outcomes of laparoscopic abdominoperineal resection (Lap-APR) for anorectal cancer. The aim of this study was to clarify the surgical outcomes of Lap-APR for anorectal cancer. Methods: A consecutive series of 39 patients who underwent abdominoperineal resection for anorectal cancer was studied: 24 underwent Lap-APR, and 15 open abdominoperineal resection (Open-APR). Patient characteristics, tumor characteristics and operative outcomes were compared between the groups. Results: There were no significant differences between the groups in patient and tumor characteristics.The mean number of harvested nodes in the Lap-APR group was significantly more than that in the Open-APR group (11.8 ± 8.7 vs.7.6 ± 3.6, p=0.046). Although the mean operation time was similar in the two groups (372.1 ± 79.0 vs.402.7 ± 118.4 min, N.S), the mean blood loss in the Lap-APR group was significantly less than that in the Open-APR group (244.6 ± 175.0 vs.795.3 ± 544.9 g, p=0.002). Additionally, time to start oral intake of solid foods and time to first education of stoma management were significantly less after Lap-APR than Open-APR. Conclusion: Lap-APR offered particular advantages to patients with anorectal cancer,including less blood loss, rapid oral intake of solid foods and education of stoma care.

Results of extralevator abdominoperineal resection for low rectal cancer including quality of life and long-term wound complications

Extralevator abdominoperineal resection (APR) for low rectal cancer has been adopted by centers to improve oncological outcome. The present study aimed to investigate oncological results, wound complications, and quality of life (QoL). Patients who underwent extralevator APR for rectal cancer between 2007 and 2011 were identified retrospectively. QoL status was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-CR30 and CR29 questionnaires. Thirty laparoscopic (n = 7) or open (n = 23) extralevator APRs were performed in 17 male and 13 female patients. The mortality was zero; circumferential margin involvement occurred in two cases (6.7 %); and there was no bowel perforation. No local recurrence was noted after a median follow-up of 28.3 months; however, six patients died, and eight developed distant metastases. Perineal wound complications were found in 46.6 % of patients, and all were managed conservatively. Fifty percent of the patients reported persistent perineal pain at the follow-up exam. QoL was assessed 7 to 46 months after surgery, and the global health status (70.6) was comparable to the EORTC reference group and published conventional APR series. The QLQ-CR29 module revealed high mean symptom scores for urinary frequency (48.1), incontinence (30.5), and impotence (79.1). Extralevator APR can control local recurrence but not distant metastases of low rectal cancer. The extended perineal resection appears not to decrease general QoL, but it results in a high rate of perineal wound complications. Genitourinary functions are often impaired, even in the long term, and further improvements to the technique must seek to reduce genitourinary harm.