Laparoscopic Versus Open Intersphincteric Resection For Low Rectal Cancer: Comparison Of Long-term Outcomes

Objective With the continuous development of surgical techniques,laparoscopic rectal cancer surgery has been widely used,but the curative effect of laparoscopic treatment for low rectal cancer is still controversial.The main purpose of this study was to compare the surgical outcomes and long-term clinical outcomes for laparoscopic versus open intersphincteric resection(ISR)in treatment of low rectal cancer,and discuss the feasibility,long-term efficacy,the advantages and disadvantages of laparoscopic ISR for the treatment of low rectal cancer.Methods A total of 141 patients with low rectal cancer who underwent ISR between January 2006 and August 2010 in our hospital were evaluated retrospectively.Patients were classified into a laparoscopy(LAP,n=81)group and an open surgery(OS,n=60)group.Use the method of clinical comparative study,the general clinical data,the operative procedures,postoperative recovery data and oncologic outcomes were compared between the two groups.Through long-term follow-up,the local recurrence rates and distant metastasis,tumor related deaths and overall survival rates were compared between the two groups.The average follow-up period in LAP group was 56.6±15.8 months,and the OS group was 58.2±18.9 months.Results The general clinical data was comparable between the LAP group and the OS group,and no significant difference was observed between the two groups(P >0.05).No perioperative death was observed in the two groups.The LAP group had less intraoperative blood loss(P <0.001),less intraoperative blood transfusion,slightly longer surgical time(P =0.192),shorter hospital stay and time to bowel movement compared with the OS group.12 cases(14.8%)experienced complications in the LAP group and 20 cases(33.3%)experienced complications in the OS group,the major complication rate in the LAP group was lower than in the OS group(P =0.009).No significant differences were observed between the two groups in negative distal margin and circumferential resection margin,number of lymph nodes resected,distance of distal resection margin to the tumor(P >0.05).No significant differences were observed between the two groups in tissue differentiation degree,and TNM staging.The LAP group the OS group both have different degrees of anal function decline,but no significant differences were observed between the two groups in anal function.The local recurrence rates,distant metastasis rates and 5-year overall survival rates were similar in the two groups,and no significant differences were observed between the two groups.The combined 5-year overall survival for all stages was 79.0% in the LAP group and 75.0% in the OS group(P =0.559).Conclusions Laparoscopic ISR can be performed safely and effectively,and can reach the therapeutic effect of radical tumor resection.The short-term outcomes and long-term outcomes of laparoscopic ISR is similar to those of traditional OS.Laparoscopic ISR can not only prolong the survival time of the tumor patients,but also improve the quality of life.Laparoscopic ISR offers a minimally invasive sphincter-sparing,less intraoperative blood loss,faster recovery,good curative effect and obvious advantages for low rectal cancer,while avoiding permanent colostomy and retaining the anus function.Laparoscopic ISR is superior to OS in perioperative recovery and rates of complications.The long-term outcome of laparoscopic ISR is similar to that of OS.The local recurrence rates,distant metastasis rates and 5-year overall survival rates are not affected in laparoscopic ISR.This study is a retrospective study,and more clinical randomized controlled trials are needed.