Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 5/2021

19.03.2021 | original article

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

verfasst von: Lam Viet Trung, Tran Vu Duc, Nguyen Vo Vinh Loc, Tran Phung Dung Tien, Nguyen Lam Vuong

Erschienen in: European Surgery | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Sie möchten Zugang zu diesem Inhalt erhalten? Dann informieren Sie sich jetzt über unsere Produkte:

Abo für kostenpflichtige Inhalte

Literatur
1.
Zurück zum Zitat Parkin DM. International variation. Oncogene. 2004;23(38):6329–40. CrossRef Parkin DM. International variation. Oncogene. 2004;23(38):6329–40. CrossRef
2.
Zurück zum Zitat Miles WE. A method of performing abdominoperineal excision for carcinoma of the rectum and the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3. CrossRef Miles WE. A method of performing abdominoperineal excision for carcinoma of the rectum and the terminal portion of the pelvic colon. Lancet. 1908;2:1812–3. CrossRef
3.
Zurück zum Zitat Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82. CrossRef Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496):1479–82. CrossRef
4.
Zurück zum Zitat Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81(9):1376–8. CrossRef Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81(9):1376–8. CrossRef
5.
Zurück zum Zitat Chen H, Ma B, Gao P, Wang H, Song Y, Tong L, et al. Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol. 2017;15(1):229. CrossRef Chen H, Ma B, Gao P, Wang H, Song Y, Tong L, et al. Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol. 2017;15(1):229. CrossRef
6.
Zurück zum Zitat Fukui Y, Kuroyanagi H, Toda S, Tomizawa K, Hanaoka Y, Matoba S. Laparoscopic intersphincteric resection of rectal cancer with posterior vaginal wall excision without hysterectomy. Tech Coloproctol. 2018;22(9):719–24. CrossRef Fukui Y, Kuroyanagi H, Toda S, Tomizawa K, Hanaoka Y, Matoba S. Laparoscopic intersphincteric resection of rectal cancer with posterior vaginal wall excision without hysterectomy. Tech Coloproctol. 2018;22(9):719–24. CrossRef
7.
Zurück zum Zitat Garcilazo-Arismendi D, Goergen M, Azagra-Soria JS. Laparoscopic ultralow anterior resection with intersphincteric dissection and delayed coloanal anastomosis in the TaTME era—a video vignette. Colorectal Dis. 2018;20(8):733–4. CrossRef Garcilazo-Arismendi D, Goergen M, Azagra-Soria JS. Laparoscopic ultralow anterior resection with intersphincteric dissection and delayed coloanal anastomosis in the TaTME era—a video vignette. Colorectal Dis. 2018;20(8):733–4. CrossRef
9.
Zurück zum Zitat Kawada K, Hida K, Hasegawa S, Sakai Y. A comparison of the long-term anorectal function between laparoscopic intersphincteric resection and low anterior resection for low rectal cancer. Surg Today. 2018;48(10):921–7. CrossRef Kawada K, Hida K, Hasegawa S, Sakai Y. A comparison of the long-term anorectal function between laparoscopic intersphincteric resection and low anterior resection for low rectal cancer. Surg Today. 2018;48(10):921–7. CrossRef
10.
Zurück zum Zitat Mahalingam S, Seshadri RA, Veeraiah S. Long-term functional and oncological outcomes following Intersphincteric resection for low rectal cancers. Indian J Surg Oncol. 2017;8(4):457–61. CrossRef Mahalingam S, Seshadri RA, Veeraiah S. Long-term functional and oncological outcomes following Intersphincteric resection for low rectal cancers. Indian J Surg Oncol. 2017;8(4):457–61. CrossRef
11.
Zurück zum Zitat Matsuhashi N, Takahashi T, Tanahashi T, Matsui S, Imai H, Tanaka Y, et al. Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor. Oncol Lett. 2017;14(4):4142–50. CrossRef Matsuhashi N, Takahashi T, Tanahashi T, Matsui S, Imai H, Tanaka Y, et al. Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor. Oncol Lett. 2017;14(4):4142–50. CrossRef
12.
Zurück zum Zitat Matsuhashi N, Takahashi T, Tanahashi T, Matsui S, Imai H, Tanaka Y, et al. Erratum: Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor. Oncol Lett. 2018;15(1):1373. PubMed Matsuhashi N, Takahashi T, Tanahashi T, Matsui S, Imai H, Tanaka Y, et al. Erratum: Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor. Oncol Lett. 2018;15(1):1373. PubMed
13.
Zurück zum Zitat Okamura R, Hida K, Yamaguchi T, Akagi T, Konishi T, Yamamoto M, et al. Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: propensity score matched analysis. Ann Gastroenterol Surg. 2017;1(3):199–207. CrossRef Okamura R, Hida K, Yamaguchi T, Akagi T, Konishi T, Yamamoto M, et al. Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: propensity score matched analysis. Ann Gastroenterol Surg. 2017;1(3):199–207. CrossRef
14.
Zurück zum Zitat Pai VD, Sugoor P, Patil PS, Ostwal V, Engineer R, Arya S, et al. Laparoscopic versus open approach for Intersphincteric resection-results from a tertiary cancer center in India. Indian J Surg Oncol. 2017;8(4):474–8. CrossRef Pai VD, Sugoor P, Patil PS, Ostwal V, Engineer R, Arya S, et al. Laparoscopic versus open approach for Intersphincteric resection-results from a tertiary cancer center in India. Indian J Surg Oncol. 2017;8(4):474–8. CrossRef
15.
Zurück zum Zitat Peng Z, Li J, Ding H. Laparoscopy combined with total intersphincteric resection for extremely low rectal cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018;43(11):1223–9. PubMed Peng Z, Li J, Ding H. Laparoscopy combined with total intersphincteric resection for extremely low rectal cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018;43(11):1223–9. PubMed
16.
Zurück zum Zitat Shirouzu K, Murakami N, Akagi Y. Intersphincteric resection for very low rectal cancer: a review of the updated literature. Ann Gastroenterol Surg. 2017;1(1):24–32. CrossRef Shirouzu K, Murakami N, Akagi Y. Intersphincteric resection for very low rectal cancer: a review of the updated literature. Ann Gastroenterol Surg. 2017;1(1):24–32. CrossRef
17.
Zurück zum Zitat Ursi P, Santoro A, Gemini A, Arezzo A, Pironi D, Renzi C, et al. Comparison of outcomes following intersphincteric resection vs low anterior resection for low rectal cancer: a systematic review. G Chir. 2018;39(3):123–42. PubMed Ursi P, Santoro A, Gemini A, Arezzo A, Pironi D, Renzi C, et al. Comparison of outcomes following intersphincteric resection vs low anterior resection for low rectal cancer: a systematic review. G Chir. 2018;39(3):123–42. PubMed
18.
Zurück zum Zitat Zhang B, Zhao K, Liu Q, Yin S, Zhuo G, Zhao Y, et al. Clinical and functional results of laparoscopic intersphincteric resection for ultralow rectal cancer: is there a distinction between the three types of hand-sewn colo-anal anastomosis? Int J Colorectal Dis. 2017;32(4):587–90. CrossRef Zhang B, Zhao K, Liu Q, Yin S, Zhuo G, Zhao Y, et al. Clinical and functional results of laparoscopic intersphincteric resection for ultralow rectal cancer: is there a distinction between the three types of hand-sewn colo-anal anastomosis? Int J Colorectal Dis. 2017;32(4):587–90. CrossRef
19.
Zurück zum Zitat Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic versus conventional open surgery in intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2018;28(2):189–200. CrossRef Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic versus conventional open surgery in intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2018;28(2):189–200. CrossRef
20.
Zurück zum Zitat Zhou H, Ruan C, Wang Z, Hu Z. Laparoscopic-assisted modified Intersphincter resection for ultralow rectal cancer. Ann Surg Oncol. 2018;25(4):947–8. CrossRef Zhou H, Ruan C, Wang Z, Hu Z. Laparoscopic-assisted modified Intersphincter resection for ultralow rectal cancer. Ann Surg Oncol. 2018;25(4):947–8. CrossRef
21.
Zurück zum Zitat Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94(10):1272–7. CrossRef Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94(10):1272–7. CrossRef
22.
Zurück zum Zitat Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97. CrossRef Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36(1):77–97. CrossRef
23.
Zurück zum Zitat Mabardy A, Lee L, Valpato AP, Atallah S. Transanal total mesorectal excision with intersphincteric resection and use of fluorescent angiography and a lighted urethral stent for distal rectal cancer. Tech Coloproctol. 2017;21(7):581–2. CrossRef Mabardy A, Lee L, Valpato AP, Atallah S. Transanal total mesorectal excision with intersphincteric resection and use of fluorescent angiography and a lighted urethral stent for distal rectal cancer. Tech Coloproctol. 2017;21(7):581–2. CrossRef
24.
Zurück zum Zitat Okada T, Kawada K, Nakamura T, Okamura R, Hida K, Takai A, et al. A cadaveric demonstration of visualization of the urethra using a lighted stent during transanal intersphincteric resection. Int Cancer Conf J. 2018;7(3):77–80. CrossRef Okada T, Kawada K, Nakamura T, Okamura R, Hida K, Takai A, et al. A cadaveric demonstration of visualization of the urethra using a lighted stent during transanal intersphincteric resection. Int Cancer Conf J. 2018;7(3):77–80. CrossRef
25.
Zurück zum Zitat Baek SJ, Kwak JM, Kim J, Kim SH, Park S, Korean Association of Robotic Surgeons Study G. Robotic rectal surgery in Korea: Analysis of a nationwide registry. Int J Med Robot. 2018;14(3):e1896. CrossRef Baek SJ, Kwak JM, Kim J, Kim SH, Park S, Korean Association of Robotic Surgeons Study G. Robotic rectal surgery in Korea: Analysis of a nationwide registry. Int J Med Robot. 2018;14(3):e1896. CrossRef
26.
Zurück zum Zitat Kang J, Hur H, Min BS, Lee KY, Kim NK. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol. 2012;19(1):154–5. CrossRef Kang J, Hur H, Min BS, Lee KY, Kim NK. Robotic coloanal anastomosis with or without intersphincteric resection for low rectal cancer: starting with the perianal approach followed by robotic procedure. Ann Surg Oncol. 2012;19(1):154–5. CrossRef
27.
Zurück zum Zitat Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2018;33(12):1741–53. CrossRef Lee SH, Kim DH, Lim SW. Robotic versus laparoscopic intersphincteric resection for low rectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2018;33(12):1741–53. CrossRef
28.
Zurück zum Zitat Liu HC, Li C, Zhang F, Wang XS, Zhang C, Luo HX, et al. Analysis on the technical characteristics and clinical efficacy of robotic-assisted intersphincteric resection for patients with low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(12):1137–43. PubMed Liu HC, Li C, Zhang F, Wang XS, Zhang C, Luo HX, et al. Analysis on the technical characteristics and clinical efficacy of robotic-assisted intersphincteric resection for patients with low rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi. 2019;22(12):1137–43. PubMed
29.
Zurück zum Zitat Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, et al. Robotic versus Laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol. 2018;25(12):3572–9. CrossRef Rouanet P, Bertrand MM, Jarlier M, Mourregot A, Traore D, Taoum C, et al. Robotic versus Laparoscopic total mesorectal excision for sphincter-saving surgery: results of a single-center series of 400 consecutive patients and perspectives. Ann Surg Oncol. 2018;25(12):3572–9. CrossRef
30.
Zurück zum Zitat Sugoor P, Verma K, Chaturvedi A, Kannan S, Desouza A, Ostwal V, et al. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: a propensity case-matched analysis. Int J Med Robot. 2019;15(1):e1965. CrossRef Sugoor P, Verma K, Chaturvedi A, Kannan S, Desouza A, Ostwal V, et al. Robotic versus laparoscopic sphincter-preserving total mesorectal excision: a propensity case-matched analysis. Int J Med Robot. 2019;15(1):e1965. CrossRef
31.
Zurück zum Zitat Hata T, Takahashi H, Sakai D, Haraguchi N, Nishimura J, Kudo T, et al. Neoadjuvant CapeOx therapy followed by sphincter-preserving surgery for lower rectal cancer. Surg Today. 2017;47(11):1372–7. CrossRef Hata T, Takahashi H, Sakai D, Haraguchi N, Nishimura J, Kudo T, et al. Neoadjuvant CapeOx therapy followed by sphincter-preserving surgery for lower rectal cancer. Surg Today. 2017;47(11):1372–7. CrossRef
32.
Zurück zum Zitat Wang M, Xue W, Zhao Z, Li Y, Wang X, Li T, et al. Laparoscopic intersphincteric resection with intraoperative radiotherapy using low-energy X‑rays for locally advanced ultra-low rectal cancer. World J Surg Oncol. 2018;16(1):133. CrossRef Wang M, Xue W, Zhao Z, Li Y, Wang X, Li T, et al. Laparoscopic intersphincteric resection with intraoperative radiotherapy using low-energy X‑rays for locally advanced ultra-low rectal cancer. World J Surg Oncol. 2018;16(1):133. CrossRef
33.
Zurück zum Zitat Toiyama Y, Hiro J, Imaoka H, Fujikawa H, Yasuda H, Kobayashi M, et al. Complete laparoscopic total mesorectal excision with an intersphincteric resection and coloplasty pouch anal anastomosis for lower rectal cancer. J Anus Rectum Colon. 2017;1(1):35–8. CrossRef Toiyama Y, Hiro J, Imaoka H, Fujikawa H, Yasuda H, Kobayashi M, et al. Complete laparoscopic total mesorectal excision with an intersphincteric resection and coloplasty pouch anal anastomosis for lower rectal cancer. J Anus Rectum Colon. 2017;1(1):35–8. CrossRef
34.
Zurück zum Zitat Tilney HS, Tekkis P. Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Colorectal Dis. 2007;10:3–16. PubMed Tilney HS, Tekkis P. Extending the horizons of restorative rectal surgery: intersphincteric resection for low rectal cancer. Colorectal Dis. 2007;10:3–16. PubMed
35.
Zurück zum Zitat Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J. Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis. 2003;5(5):451–3. CrossRef Bretagnol F, Rullier E, Couderc P, Rullier A, Saric J. Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis. 2003;5(5):451–3. CrossRef
Metadaten
Titel
Laparoscopic intersphincteric resection with hand-sewn coloanal anastomosis in the treatment of low rectal cancer: 10-year experience
verfasst von
Lam Viet Trung
Tran Vu Duc
Nguyen Vo Vinh Loc
Tran Phung Dung Tien
Nguyen Lam Vuong
Publikationsdatum
19.03.2021
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 5/2021
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-021-00694-z