Laparoscopic abdominoperineal resection for anorectal cancer

The use of the laparoscopic technique in treating colorectal malignancies for cure is still a controversial issue. The aim of this study was to evaluate the outcome of laparoscopic abdominoperineal resection (APR) in treating malignancies of the lower rectum and anus and to compare the results with patients of matched age and diagnosis treated by conventional open APR by the same surgeon during the same time period. Between August 1991 and December 1996, we performed 235 laparoscopic colorectal procedures, including 8 laparoscopic APRs for malignancies of the lower rectum or anus. There were 6 female and 2 male patients of a mean age of 67 years. Pathologies included 4 adenocarcinomas, 2 melanomas, 1 leiomyosarcoma, and 1 squamous cell carcinoma. Four procedures were laparoscopically completed, and 3 were laparoscopic-assisted. One was converted to an open procedure due to dense adhesions. Five procedures were performed with palliative intent, whereas 3 were performed with curative intent. These patients were evaluated for procedural safety, distal and lateral resection margins, number of lymph nodes harvested, operative time, postoperative ileus, length of hospital stay, morbidity, and mortality. Results were compared with 7 conventional APRs performed between 1991 and 1996, 5 of which were performed for palliation. Histologic studies of the specimen demonstrated free lateral resection margins in all cases in both groups. No differences were noted in the mean free distal resection margins among the four groups: laparoscopic, 2.5 cm; laparoscopic-assisted, 3 cm; converted, 6 cm; and open, 3.6 cm. Mean lymph node harvest was 9, 9, 9, and 10 nodes, respectively. Mean length of surgery was 181, 198, 240, and 131 minutes, respectively. The length of postoperative ileus was 3.2, 7, 3, and 5.9 days, respectively. Mean postoperative length of stay was 6.5, 7, 6, and 12.5 days, respectively. Morbidity was 25 per cent in the laparoscopy group and 43 per cent in the open group. There was no 30-day postoperative mortality recorded in any group. Laparoscopic APR is associated with a 50 per cent reduction in the length of hospitalization without any compromise to lateral or distal resection margins, number of lymph nodes harvested, or morbidity.