Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Versus Open Approach for Intersphincteric Resection—Results from a Tertiary Cancer Center in India

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

The study aims to compare open intersphincteric resection (OISR) with laparoscopic intersphincteric resection (LISR) in terms of short-term oncological and clinical outcomes. This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent intersphincteric resection (ISR) at Tata Memorial Centre between 1st July 2013 and 30th November 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), distal resection margin involvement, and number of nodes harvested. Perioperative outcomes included blood loss, length of hospital stay and 30-day postoperative morbidity and mortality. Chi-square test was used to compare the results between the two groups. Thirty nine cases of OISR and 34 cases of LISR were included in the study. Median BMI was higher in LISR group; otherwise, the two groups were comparable in all aspects. There were no conversions in LISR group. CRM involvement was seen in four patients (10%) in the conventional group compared to none in the LISR group. Median hospital stay was comparable between the two groups. Laparoscopic ISR is safe and can be performed with low conversion rate in selected group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M (1994) Intersphincteric resection for low rectal tumours. Br J Surg 81(9):1376–1378

    Article  CAS  PubMed  Google Scholar 

  2. Martin ST, Heneghan HM, Winter DC (2012) Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 99(5):603–612

    Article  CAS  PubMed  Google Scholar 

  3. Akagi Y, Shirouzu K, Ogata Y, Kinugasa T (2013) Oncologic outcomes of intersphincteric resection without preoperative chemoradiotherapy for very low rectal cancer. Surg Oncol 22(2):144–149

    Article  PubMed  Google Scholar 

  4. Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F (2007) Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg 94(3):341–345

    Article  CAS  PubMed  Google Scholar 

  5. Saito N, Sugito M, Ito M, Kobayashi A, Nishizawa Y, Yoneyama Y et al (2009) Oncologic outcome of intersphincteric resection for very low rectal cancer. World J Surg 33(8):1750–1756

    Article  PubMed  Google Scholar 

  6. Akagi Y, Kinugasa T, Shirouzu K (2013) Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today 43(8):838–847

    Article  PubMed  Google Scholar 

  7. Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44(3):315–321

    Article  CAS  PubMed  Google Scholar 

  8. Kang S-B, Park JW, Jeong S-Y, Nam BH, Choi HS, Kim D-W et al (2010) Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 11(7):637–645

    Article  PubMed  Google Scholar 

  9. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–218

    Article  PubMed  Google Scholar 

  10. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726

    Article  PubMed  Google Scholar 

  11. Watanabe M, Teramoto T, Hasegawa H, Kitajima M (2000) Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum 43(10 Suppl):S94–S97

    Article  CAS  PubMed  Google Scholar 

  12. Fujimoto Y, Akiyoshi T, Kuroyanagi H, Konishi T, Ueno M, Oya M et al (2010) Safety and feasibility of laparoscopic intersphincteric resection for very low rectal cancer. J Gastrointest Surg 14(4):645–650

    Article  PubMed  Google Scholar 

  13. Pai VD, Desouza A, De Menezes JL, Saklani AP (2015) Laparoscopic intersphincteric resection and hand-sewn coloanal anastomosis: a natural orifice specimen extraction technique. J Laparoendosc Adv Surg Tech A 25(5):396–400

    Article  PubMed  Google Scholar 

  14. Park JS, Choi G-S, Jun SH, Hasegawa S, Sakai Y (2011) Laparoscopic versus open intersphincteric resection and coloanal anastomosis for low rectal cancer: intermediate-term oncologic outcomes. Ann Surg 254(6):941–946

    Article  PubMed  Google Scholar 

  15. Kuo L-J, Hung C-S, Wang W, Tam K-W, Lee H-C, Liang H-H et al (2013) Intersphincteric resection for very low rectal cancer: clinical outcomes of open versus laparoscopic approach and multidimensional analysis of the learning curve for laparoscopic surgery. J Surg Res 183(2):524–530

    Article  PubMed  Google Scholar 

  16. Weiser MR, Quah H-M, Shia J, Guillem JG, Paty PB, Temple LK et al (2009) Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg 249(2):236–242

    Article  PubMed  Google Scholar 

  17. Spanos CP (2012) Intersphincteric resection for low rectal cancer: an overview. Int J Surg Oncol 2012:241512

    PubMed  PubMed Central  Google Scholar 

  18. Pai VD, De Souza A, Patil P, Engineer R, Arya S, Saklani A (2015) Intersphincteric resection and hand-sewn coloanal anastomosis for low rectal cancer: short-term outcomes in the Indian setting. Indian J Gastroenterol 34(1):23–28

    Article  PubMed  Google Scholar 

  19. Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90(4):445–451

    Article  CAS  PubMed  Google Scholar 

  20. Yamamoto S, Fujita S, Akasu T, Inada R, Takawa M, Moriya Y (2011) Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach. Dig Surg 28(5–6):404–409

    Article  PubMed  Google Scholar 

  21. Yoo B-E, Cho J-S, Shin J-W, Lee D-W, Kwak J-M, Kim J et al (2015) Robotic versus laparoscopic intersphincteric resection for low rectal cancer: comparison of the operative, oncological, and functional outcomes. Ann Surg Oncol 22(4):1219–1225

    Article  PubMed  Google Scholar 

  22. Chapman AE, Levitt MD, Hewett P, Woods R, Sheiner H, Maddern GJ (2001) Laparoscopic-assisted resection of colorectal malignancies: a systematic review. Ann Surg 234(5):590–606

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Mumbai, Maharashtra, 400012, India

    Vishwas D. Pai, Pavan Sugoor, Ashwin Desouza & Avanish P. Saklani

  2. Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India

    Prachi S. Patil

  3. Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India

    Vikas Ostwal

  4. Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India

    Reena Engineer

  5. Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, 400012, India

    Supreeta Arya

Authors
  1. Vishwas D. Pai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pavan Sugoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prachi S. Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vikas Ostwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Reena Engineer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Supreeta Arya
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ashwin Desouza
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Avanish P. Saklani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Avanish P. Saklani.

Ethics declarations

Conflicts of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pai, V.D., Sugoor, P., Patil, P.S. et al. Laparoscopic Versus Open Approach for Intersphincteric Resection—Results from a Tertiary Cancer Center in India. Indian J Surg Oncol 8, 474–478 (2017). https://doi.org/10.1007/s13193-017-0672-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13193-017-0672-z

Keywords

Search

Navigation