Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience

Intersphincteric resection (ISR) with hand-sewn coloanal anastomosis (CAA) has been proposed as an alternative to abdominoperineal resection (APR) for low rectal cancer. However, there is still lack of evidence regarding long-term outcomes of this procedure. Therefore, the aim of this study is to evaluate the feasibility, safety, and long-term results of this surgery.

This is a prospective study conducted from 2009–2019. Patients with low rectal cancer lying in 3–5 cm from the anal verge graded as T1–T3 were included. Laparoscopic ISR and hand-sewn CAA with inverted ileostomy were performed in all patients. Perioperative and long-term functional and oncological outcomes were investigated.

There were 39 patients (25 men and 14 women) with the mean age of 54.5 years. The mean operating time and postoperative hospital stay were 196 ± 18 min and 7.1 ± 0.7 days. No complication or mortality occurred within 30 days postoperatively. Three late complications occurred: two anastomotic leakages and one anastomotic stricture. Mean follow-up duration was 45.6 months. There was no recurrence and most patients were satisfied with the preserved anus (mean Wexner incontinence score was 6.4 and 3.1 at 6 and 12 months, respectively). Three individuals (7.7%) had distant metastasis and two died. The disease-free survival and overall survival probabilities were 90.8% and 91.6% at 5 years.

Laparoscopic ISR with hand-sewn CAA is feasible, safe and has good long-term outcomes for low rectal cancer and might be a good alternative to APR. More studies are required to better improve long-term outcomes of this surgery.