Comparative Study On Laparoscopic Intersphincteric Resection Of Rectal Cancer Versus Open Surgery

Objective In recent years, with the further clarification of the law of rectal anatomy and lymphatic drainage as well as the further development of laparoscopic techniques, for ultra-low rectal cancer within5cm away from the anal margin, a new surgical way which is based on the traditional Mile’s surgery has emerged, and it is laparoscopic intersphincteric resection of ultra-low rectal cancer. However, the operation safety, eradication, complications, postoperative survival rate has always been the focus of debate. This research analyzes and demonstrates the safety and feasibility of laparoscopic intersphincteric resection of ultra-low rectal cancer by comparing corresponding observation index of laparoscopic operation with traditional open surgery.Methods This study using the methodology of prospective non-randomized comparison, according to the preferred surgical method of the patients or clients, divides rectal cancer patients from the General Department of Nanyang Central Hospital during the period of September2009to January2011into two groups:the laparoscopic group (group LAP) and traditional open surgery group (group OP). There is19people in group LAP and27people in group OP.This is done in a non-random way after the screening by inclusion criteria and exclusion criteria. Through collecting preoperative, intraoperative, postoperative, postoperative follow-up information, this study compares preoperative, intraoperative observation index, blood sugar (BG), insulin (Ins), three triiodothyronine (T3), triiodothyronine (T4), thyrotropin stimulating hormone (TSH) content,which the stress level of the patients; the study compares T cell subpopulation quantity, the number of NK cells and plasma immunoglobulin IgA, IgG, IgM content which reflects the immune function of the patients. The study evaluates postoperative anal function recovery of the LAP group patients demonstrate the safety and feasibility of the Laparoscopic intersphincteric resection of ultra-low rectal cancer. Statistical analysis of data:SPSS13.0statistical software is used to analyze the statistics. The measured statistics is shown in mean4-standard deviation (x±S),Analysis of variance of repeated measured data is used in the statistical comparison of normal distribution in the two groups; while the pair wise comparison using the LSD method. Data comparison of the normal distribution between the two groups uses the Independent Samples T Test. Countable data is checked by using the non-correction and correction chi—square(x2)and Fisher probabilities in2X2table test.Results The operation time (146.1±30.2min) in the LAP group is longer than that of the OP group (88.1±8.7min), the difference was statistically significant (P<0.05); Intraoperative bleeding volume in group LAP (95.8±8.4ml)is less than in group OP(199.8±44.4ml), the difference was statistically significant (P<0.05); bowel resection, lymph node dissection length number, the occurrence of postoperative complications between the two groups has no significant statistical difference (P>0.05), and postoperative gastrointestinal function recovery time and the patient is hospitalized time in LAP group were less than that in OP group, the difference was statistically significant (P<0.05); the postoperative anal function of the patients in group LAP returns to able to independently control the defecation in6months. In two groups of patients with stress level comparison, patients in group LAP BG, Ins, T3, T4, TSH changes with OP group showed no significant statistical differences (P>0.05); But it can be seen from the two groups of patients with BG, Ins, T3, T4, TSH changing curve, the recovery time compared with the OP group is soon. Compared the immune function changes of patients in two groups, In LAP group, T cell subsets and NK cell number, the number of plasma immunoglobulin content compared with the OP group showed no significant statistical difference (P>0.05), But it can be seen form T cell subsets and NK cell number, the number of plasma immunoglobulin content changing curve in two groups that postoperative immune function inhibition recovery time is shorter than that in group OP.Conclusions1、Laparoscopic intersphincteric resection of ultra-low rectal cancer it is able to make the patients with rectal cancer away from anal edge within5cm anus successfully, the anal function returns to normal in one year; 2、The recovery time of postoperative gastrointestinal function and hospitalization time of the patients with Laparoscopic intersphincteric resection of ultra-low rectal cancer is short compared with open surgery; It is no significant statistical difference in two groups to tumor resection, lymph node dissection, postoperative complications, postoperative survival rate;3、The stress response in patients with Laparoscopic intersphincteric resection of ultra-low rectal cancer compared with open surgery was no significant statistical difference;4、The immune function in patients with Laparoscopic intersphincteric resection of ultra-low rectal cancer compared with open surgery was no significant statistical difference.