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Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer

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Abstract

Background

The Laparoscopic approach has been applied to colorectal surgery for many years; however, there are only a few reports on laparoscopic low and ultralow anterior resection with construction of coloanal anastomosis. This study compares open versus laparoscopic low and ultralow anterior resections, assesses the feasibility and efficacy of the laparoscopic approach of total mesorectal excision (TME) with anal sphincter preservation (ASP), and analyzes the short-term results of patients with low rectal cancer.

Methods

We analyzed our experience via a prospective, randomized control trail. From June 2001 to September 2002, 171 patients with low rectal cancer underwent TME with ASP, 82 by the laparoscopic procedure and 89 by the open technique. The lowest margin of tumors was below peritoneal reflection and 1.5–8 cm above the dentate line (1.5–4.9 cm in 104 cases and 5–8 cm in 67 cases). The grouping was randomized.

Results

Results of operation, postoperative recovery, and short-term oncological follow-up were compared between 82 laparoscopic procedures and 89 controls who underwent open surgery during the same period. In the laparoscopic group, 30 patients in whom low anterior resection was performed had the anastomosis below peritoneal reflection and more than 2 cm above the dentate line, 27 patients in whom ultralow anterior resection was performed had anastomotic height within 2 cm of the dentate line, and 25 patients in whom coloanal anastomosis was performed had the anastomosis at or below the dentate line. In the open group, the numbers were 35, 27, and 27, respectively. There was no statistical difference in operation time, administration of parenteral analgesics, start of food intake, and mortality rate between the two groups. However, blood loss was less, bowel function recovered earlier, and hospitalization time was shorter in the laparoscopic group.

Conclusion

Totally laparoscopic TME with ASP is feasible, and it is a minimally invasive technique with the benefits of much less blood loss during operation, earlier return of bowel function, and shorter hospitalization.

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References

  1. SM Aleshkina AL Andreev SN, Petrov et al. (1999) ArticleTitleLaparoscopic surgery in colorectal tumors Vestn Khir Im II Grek 158 65–66 Occurrence Handle1:STN:280:DC%2BD3c7htVWrsA%3D%3D

    CAS  Google Scholar 

  2. E Barlehner T Decker S Anders B Heukrodt (2001) ArticleTitleLaparoscopic surgery of rectal carcinoma. Radical oncology and late results Zentralbl Chir 126 302–306 Occurrence Handle10.1055/s-2001-14745 Occurrence Handle1:STN:280:DC%2BD3M3ntlSkug%3D%3D Occurrence Handle11370393

    Article  CAS  PubMed  Google Scholar 

  3. M Braga A Vignali L Gianotti W, Zuliani et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery: a randomized trial on short-term outcome Ann Surg 236 759–767 Occurrence Handle10.1097/00000658-200212000-00008 Occurrence Handle12454514

    Article  PubMed  Google Scholar 

  4. HP Bruch O Schwandner (2001) ArticleTitleCurrent status of laparoscopic surgery in colorectal cancer Onkologie 24 29–32 Occurrence Handle10.1159/000050278 Occurrence Handle1:STN:280:DC%2BD3MzptlSjsg%3D%3D Occurrence Handle11441277

    Article  CAS  PubMed  Google Scholar 

  5. GG Champault C, Barrat et al. (2002) ArticleTitleLaparoscopic versus open surgery for colorectal carcinoma: a prospective clinical trial involving 157 cases with a mean follow-up of 5 years Surg Laparosc Endosc Percutan Tech 12 88–95 Occurrence Handle10.1097/00129689-200204000-00003 Occurrence Handle11948293

    Article  PubMed  Google Scholar 

  6. CC Chung JP Ha WW Tsang MK Li (2001) ArticleTitleLaparoscopic-assisted total mesorectal excision and colonic J pouch reconstruction in the treatment of rectal cancer Surg Endosc 15 1098–1101 Occurrence Handle10.1007/s00464-001-9000-2 Occurrence Handle1:STN:280:DC%2BD3MnotV2jug%3D%3D Occurrence Handle11727078

    Article  CAS  PubMed  Google Scholar 

  7. F Gomis ParticleDelgado JM Bolufer Cano E, Grau Cardona et al. (1998) ArticleTitleEarly results of laparoscopic resection of colorectal cancer Rev Esp Enferm Dig 90 323–334 Occurrence Handle9656752

    PubMed  Google Scholar 

  8. VW Fazio F Lopes-kostner (2000) ArticleTitleRole of laparoscopic surgery for treatment of early colorectal carcinoma World J Surg 24 1056–1060 Occurrence Handle10.1007/s002680010145 Occurrence Handle1:STN:280:DC%2BD3cvos12mtA%3D%3D Occurrence Handle11036282

    Article  CAS  PubMed  Google Scholar 

  9. S Goldberg JV Klas (1998) ArticleTitleTotal mesorectal excision in the treatment of rectal cancer: a view from the USA Semin Surg Oncol 15 87–90 Occurrence Handle10.1002/(SICI)1098-2388(199809)15:2<87::AID-SSU5>3.0.CO;2-1 Occurrence Handle1:STN:280:DyaK1czpvVWrsA%3D%3D Occurrence Handle9730414

    Article  CAS  PubMed  Google Scholar 

  10. JE Hartley BJ, Mehigan et al. (2000) ArticleTitlePatterns of recurrence and survival after laparoscopic and conventional resections for colorectal carcinoma Ann Surg 232 181–186 Occurrence Handle10.1097/00000658-200008000-00005 Occurrence Handle1:STN:280:DC%2BD3cvgvVGmtA%3D%3D Occurrence Handle10903594

    Article  CAS  PubMed  Google Scholar 

  11. JE Hartley BJ Mehigan AE Qureshi GS Duthie PW Lee JR Monson (2001) ArticleTitleTotal mesorectal excision: assessment of the laparoscopic approach Dis Colon Rectum 44 315–321 Occurrence Handle1:STN:280:DC%2BD3M7pvFyktw%3D%3D Occurrence Handle11289275

    CAS  PubMed  Google Scholar 

  12. RJ Heald (1995) ArticleTitleTotal mesorectum excision is optimal surgery for rectal cancer: a Scandinavian consensus Br J Surg 82 1297–1299 Occurrence Handle1:STN:280:BymD1MjotVw%3D Occurrence Handle7489148

    CAS  PubMed  Google Scholar 

  13. RJ Heald (2000) ArticleTitleTotal mesorectal exsicion (TME) Acta Chir Iugosl 47 IssueIDsuppl 1 17–18 Occurrence Handle1:STN:280:DC%2BD3Mzns1Wmuw%3D%3D

    CAS  Google Scholar 

  14. RJ Heald RK Smedh A Kald R Sexton BJ Moran (1997) ArticleTitleAbdominoperineal excision of the rectum—an endangered operation Dis Colon Rectum 40 747–751 Occurrence Handle1:STN:280:ByiA28vovFM%3D Occurrence Handle9221846

    CAS  PubMed  Google Scholar 

  15. PM Hewitt SM Ip SP Kwok SS, Somer et al. (1998) ArticleTitleLaparoscopic-assisted vs open surgery for colorectal cancer: comparative study of immune effects Dis Colon Rectum 41 901–909 Occurrence Handle1:STN:280:DyaK1czktFGiug%3D%3D Occurrence Handle9678378

    CAS  PubMed  Google Scholar 

  16. D Hong J Tabet M Anvari (2001) ArticleTitleLaparoscopic vs open resection for colorectal adenocarcinoma Dis Colon Rectum 44 10–19 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGjtw%3D%3D Occurrence Handle11805558

    CAS  PubMed  Google Scholar 

  17. AJ Iroatulam F Agachan O, Alabaz et al. (1998) ArticleTitleLaparoscopic abdominoperineal resection for anorectal cancer Am Surg 64 12–18 Occurrence Handle1:STN:280:DyaK1c7hvVWntQ%3D%3D Occurrence Handle9457031

    CAS  PubMed  Google Scholar 

  18. E Kapiteijn CA Marijnen ID Nagtegaal H Putter WH Steup T Wiggers HJ Rutten L Pahlman B Glimelius JH Krieken Particlevan JW Leer CJ Velde Particlevan de (2001) ArticleTitleDutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–646 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D Occurrence Handle11547717

    Article  CAS  PubMed  Google Scholar 

  19. TM Khaili PR Fleshner JR, Hiatt et al. (1998) ArticleTitleColorectal cancer: comparison of laparoscopic with open approaches Dis Colon Rectum 41 832–838 Occurrence Handle1:STN:280:DyaK1czktFGjtQ%3D%3D Occurrence Handle9678367

    CAS  PubMed  Google Scholar 

  20. F Kockerling J Rose C Schneider H, Scheidbach et al. (1999) ArticleTitleLaparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG) Surg Endosc 13 639–644 Occurrence Handle10.1007/s004649901064 Occurrence Handle1:STN:280:DyaK1Mzhs1erug%3D%3D Occurrence Handle10384066

    Article  CAS  PubMed  Google Scholar 

  21. KL Leung SP Kwok WY, Lau et al. (1997) ArticleTitleLaparoscopic-assisted resection of rectosigmoid carcinoma. Immediate and medium-term results Arch Surg 132 761–765 Occurrence Handle1:STN:280:ByiA2svktFc%3D Occurrence Handle9230862

    CAS  PubMed  Google Scholar 

  22. KL Leung SP Kwok WC, Meng et al. (2000) ArticleTitleLaparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma Surg Endosc 14 67–70 Occurrence Handle10.1007/s004649900014 Occurrence Handle1:STN:280:DC%2BD3c7hs12nsw%3D%3D Occurrence Handle10653240

    Article  CAS  PubMed  Google Scholar 

  23. KL Leung Ry, Yiu et al. (1999) ArticleTitleLaparoscopic-assisted resection of colorectal carcinoma: five-year audit Dis Colon Rectum 42 327–333 Occurrence Handle1:STN:280:DyaK1M3jvValtQ%3D%3D Occurrence Handle10223751

    CAS  PubMed  Google Scholar 

  24. E Lezoche F Feiciotti AM Paganini M, Guerrieri et al. (2002) ArticleTitleResults of laparoscopic versus open resections for non-early rectal cancer in patients with a minimum follow-up of four years Hepatogastroenterology 49 1185–1190 Occurrence Handle12239902

    PubMed  Google Scholar 

  25. GB Makin DJ Breen JRT Monson (2001) ArticleTitleThe impact of new technology on surgery for colorectal cancer World J Gastroenterol 7 612–621 Occurrence Handle1:STN:280:DC%2BD387pvV2mtA%3D%3D Occurrence Handle11819841

    CAS  PubMed  Google Scholar 

  26. C Mavrantonis SD Wexner JJ, Nogueras et al. (2002) ArticleTitleCurrent attitudes in laparoscopic colorectal surgery Surg Endosc 16 1152–1157 Occurrence Handle10.1007/s004640080072 Occurrence Handle1:STN:280:DC%2BD38vjt1ehsw%3D%3D Occurrence Handle12015620

    Article  CAS  PubMed  Google Scholar 

  27. JW Milsom B Bohm KA Hammerhofer V, Fazio et al. (1998) ArticleTitleA prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report J Am Coll Surg 187 46–55 Occurrence Handle10.1016/S1072-7515(98)00132-X Occurrence Handle1:STN:280:DyaK1czitFClsw%3D%3D Occurrence Handle9660024

    Article  CAS  PubMed  Google Scholar 

  28. CB Molenaar AB Bijnen P Ruiter Particlede (1998) ArticleTitleIndications for laparoscopic colorectal surgery. Results from the Medical Centre Alkmaar, The Netherlands Surg Endosc 12 42–45 Occurrence Handle10.1007/s004649900589 Occurrence Handle1:STN:280:DyaK1c%2Fos1yhtg%3D%3D Occurrence Handle9419301

    Article  CAS  PubMed  Google Scholar 

  29. S Pasupathy KW Eu YH, Ho et al. (2001) ArticleTitleA comparison between open versus laparoscopic assisted colonic pouches for rectal cancer Tech Coloproctol 5 19–22 Occurrence Handle1:STN:280:DC%2BD38%2FmsF2lsg%3D%3D Occurrence Handle11793255

    CAS  PubMed  Google Scholar 

  30. AJ Pikarsky R Rosenthal EG Weiss SD Wexner (2002) ArticleTitleLaparoscopic total mesorectal excision Surg Endosc 16 558–562 Occurrence Handle10.1007/s00464-001-8250-3 Occurrence Handle1:STN:280:DC%2BD383jsVeksA%3D%3D Occurrence Handle11972187

    Article  CAS  PubMed  Google Scholar 

  31. HM Quah DG Jayne KW, Eu et al. (2002) ArticleTitleBladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer Br J Surg 89 l551–1556 Occurrence Handle10.1046/j.1365-2168.2002.02275.x

    Article  Google Scholar 

  32. E Santoro M Carlini F Carboni A Feroce (1999) ArticleTitleColorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial Hepatogastroenterology 46 900–904 Occurrence Handle1:STN:280:DyaK1M3pvVOksQ%3D%3D

    CAS  Google Scholar 

  33. CM Schlachta J Mamazza PA Seshadri M, Cadeddu et al. (2000) ArticleTitleDeterminants of outcomes in laparoscopic colorectal surgery: a multiple regression analysis of 416 resections Surg Endosc 14 258–263 Occurrence Handle10.1007/s004640000050 Occurrence Handle1:STN:280:DC%2BD3c3gtlCruw%3D%3D Occurrence Handle10741445

    Article  CAS  PubMed  Google Scholar 

  34. O Schwander TH Schiedeck C, Killaitis et al. (1999) ArticleTitleA case–control study comparing laparoscopic versus open surgery for rectosigmoidal and rectal cancer Int J Colorectal Dis 14 158–163 Occurrence Handle10.1007/s003840050203 Occurrence Handle1:STN:280:DyaK1MzptFyhtg%3D%3D Occurrence Handle10460907

    Article  CAS  PubMed  Google Scholar 

  35. M Watanabe T Teramoto H Hasegawa M Kitajima (2000) ArticleTitleLaparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer Dis Colon Rectum 43 S94–S97 Occurrence Handle1:STN:280:DC%2BD3crgtl2gtg%3D%3D Occurrence Handle11052484

    CAS  PubMed  Google Scholar 

  36. JC Weeks H Nelson S Gelber D, Sargent et al. (2002) ArticleTitleShort-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial J Am Med Assoc 287 321–328 Occurrence Handle10.1001/jama.287.3.321

    Article  Google Scholar 

  37. S Yamamoto M Watanabe H, Hasegawa et al. (1998) ArticleTitleClinical, pathologic, and economic parameters of laparoscopic colon resection for cancer Am J Surg 176 554–558 Occurrence Handle10.1016/S0002-9610(98)00261-X Occurrence Handle9926789

    Article  PubMed  Google Scholar 

  38. L Yong M Deane JR Monson A Darzi (2001) ArticleTitleSystematic review of laparoscopic surgery for colorectal malignancy Surg Endosc 15 1431–1439 Occurrence Handle1:STN:280:DC%2BD383ivVSktA%3D%3D Occurrence Handle11965460

    CAS  PubMed  Google Scholar 

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Acknowledgment

This work was supported by the key project of the National Outstanding Youth Foundation of China (Grant No. 39925032).

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Authors and Affiliations

  1. Department of General Surgery and Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, PR China

    Z. -G. Zhou, M. Hu, Y. Li, W. -Z. Lei, Y. -Y. Yu, Z. Cheng, L. Li, Y. Shu & T. -C. Wang

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  1. Z. -G. Zhou
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  2. M. Hu
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Correspondence to Y. Li.

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Zhou, Z.G., Hu, M., Li, Y. et al. Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer. Surg Endosc 18, 1211–1215 (2004). https://doi.org/10.1007/s00464-003-9170-1

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