Laparoscopic Versus Open Intersphincteric Resection and Coloanal Anastomosis for Low Rectal Cancer

Abstract

To compare the surgical outcome and intermediate oncological outcomes for laparoscopic versus open intersphincteric resection (ISR). Intersphincteric resection has been proposed as an alternative to abdominoperineal resection for selected low rectal cancer cases, but the oncological adequacy of laparoscopic ISR has not been established. A total of 210 consecutive patients with low rectal cancer who underwent ISR between 1997 and 2009 in 2 institutions were evaluated retrospectively. Patients were classified into an open surgery (OS, n = 80) group and a laparoscopy (LAP, n = 130) group. The primary endpoint was 3-year disease-free survival. The major complication rates were similar in the LAP and OS groups (5.4% vs 3.8%, respectively; P = 0.428). However, the LAP group had a shorter hospital stay and time to bowel movement compared with the OS group. In the LAP group, operating time was 16 minutes shorter (P = 0.230) and intraoperative blood loss was less (P = 0.002). Median follow-up was 34 months (interquartile range: 20.0-42.5 months). The local recurrence rates were similar in the 2 groups (LAP, 2.6% vs OS, 7.7%; P = 0.184). The combined 3-year disease-free survival for all stages was 82.1% (95% CI: 73.7-90.2%) in the LAP group and 77.0% (95% CI: 66.9%-86.9%) in the OS group (P = 0.523). Laparoscopic ISR can be performed safely and offers a minimally invasive sphincter-sparing alternative. The oncological adequacy of laparoscopic ISR requires long-term follow-up data, but the intermediate-term outcomes seem equivalent to those achieved with OS.