Efficacy And Safety Of Laparoscopic Internal Sphincter Resection For Lower Rectal Cancer

Purpose:We extract the information of patients who have undergone laparoscopic sphincter interresection in recent years at our hospital and compare it with patients with low rectal cancer who have undergone prelaparoscopic laparoscopic resection and abdominal perineectomy,and analyze the efficacy and safety of laparoscopic sphincter interresection in low rectal cancer.Method:We conducted a retrospective analysis of patients with low rectal cancer who underwent surgery at our clinic between January 2019 and January 2022,and selected 164 patients based on inclusion and exclusion criteria.Of these,42 were treated with laparoscopic intersphincter resection(ISR)as an observed arm,while 54 were treated with laparoscopic low anterior resection(LAR)and68 were treated with laparoscopic gastroperinetic resection(Miles)at the same time as controls.The efficacy and safety of treatment with laparoscopic sphincter interresection of low rectal cancer was analyzed by collating data from three groups and comparing postoperative/postoperative and long-term prognosis in the ISR,LAR,and Miles groups.Results:1.Comparison of clinical data :164 patients were divided into three groups and all cases were followed up successfully.The average follow-up period was24 months,but LAR was not significantly different compared to ISR(P> 0.05);In the Miles group,the lower margin of the tumor was closer to the anal margin than in the ISR group(3.49±0.69 cm vs.3.92±0.69cm;P=0.002),and the difference was statistically significant.2.Comparison of intraoperative and postoperative recovery: Although 164 patients underwent laparoscopy and successfully completed surgery,there was no statistically significant difference between ISR group and LAR group in the duration of surgery,intraoperative bleeding,and number of days in hospital after surgery(P> 0.05).However,ISR had shorter hospitalization(11.00±4.13 days vs.12.82±3.10 days;P=0.010)than Miles,and intraoperative bleeding(54.24±13.45 ml vs.60.16±13.75 ml,P=0.029)was reduced.Time to pass the entire drain(10.17±1.40 days vs 11.00 days.P=0.002)was earlier and statistically significant than the miles group.Compared to LAR,the ISR group did not differ statistically significantly in the comparison of measures such as tumor size,number of intraoperative clean-up lymph nodes,or pathologic staging of the tumor(P> 0.05)and the tumor size in the ISR group(3.02±0.87 cm vs.3.42±1.13cm;P=0.046)was smaller than that in the Miles group,and there was a statistically significant difference.3.Clinical complications comparison:9(21.4%)postoperative complications occurred in the ISR group,11(20.4%)in the LAR group,and 22(32.4%)in the Miles group.There was no statistically significant difference in the incidence of various complications between the ISR and LAR groups(P> 0.05).In the ISR group,small mouth infection was lower than in the Miles group(2 patients vs.14 patients;P=0.022),and there was a statistically significant difference.4.Comparison of anal function: Patients who underwent prophylactic ostomy in the ISR and LAR groups were excluded.9 patients in the ISR group and 18 patients in the LAR group were followed up.LARS score was used to evaluate the low anterior excision syndrome and its severity at 3,6,and 12 months after surgery.We evaluated the removal of syndromes and severity.Observation periods were assessed in 32 patients in the ISR group and 35 in the LAR group at 3,6,and 12 months after redelivery,with no significant results for anal function recovery.However,there are some patients with severe symptoms.5.Comparative survival prognosis: The mean follow-up period was 24 months.In the LAR group,two patients had local recurrence(3.7%)and three patients had distant metastases(5.6%),with a disease-free survival rate of90.7%.In the miles group,three patients(4.4%)had local recurrence and four patients(5.9%)had distant metastasis.The ISR group had no statistically significant prognostic survival difference compared to LAR or Miles(P> 0.05).Conclusion:1.Treatment by laparoscopic intersphincter resection low rectal cancer is safe,has no effect on survival compared to conventional abdominal perinetomy,recovery is fast,and postoperative complications are few.2.Laparoscopic intersphincter resection treatment of low rectal cancer and low preresection treatment have the same effect and can maintain the purpose of the anus while meeting the requirements of radical tumor.3.Laparoscopic intersphincter resection syndrome will occur after the surgery,and it will gradually improve after the surgery.After 12 months,some patients’ symptoms may ease.