Laparoscopic intersphincteric resection for low rectal cancer.

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Laparoscopic intersphincteric resection (ISR) is a valuable technique for managing low rectal cancer, particularly after neoadjuvant chemoradiation.
• This approach potentially decreases the need for abdominoperineal resection in patients with very low rectal tumors.

Purpose of the Study:

• To evaluate the feasibility of laparoscopic ISR for low rectal adenocarcinoma.
• To assess the functional and short-term oncologic outcomes of this sphincter-saving procedure.

Main Methods:

• Retrospective review of 111 patients who underwent laparoscopic ISR for low rectal adenocarcinoma (July 2005 - December 2009).
• Data collected included demographics, surgical outcomes, functional outcomes (Wexner continence score), and oncologic outcomes (survival, recurrence).

Main Results:

• The mean tumor distance from the anal verge was 3.4 cm. Mean operative time was 214.7 minutes.
• Morbidity occurred in 21.6% of patients, with a low anastomotic leakage rate (1.8%).
• Three-year overall survival was 92.8%, and disease-free survival was 73.0%. Local recurrence was 5.4%. Tumors within 2 cm of the dentate line had a significantly higher risk of local recurrence.

Conclusions:

• Laparoscopic ISR is a technically feasible and minimally invasive sphincter-saving option for very low rectal cancer.
• The procedure demonstrates acceptable functional and short-term oncologic outcomes.
• Neoadjuvant chemoradiation followed by laparoscopic ISR can be recommended for carefully selected patients.