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Surgical Endoscopy

, Volume 27, Issue 9, pp 3452–3464 | Cite as

Comparison of tumor recurrence between laparoscopic total mesorectal excision with sphincter preservation and laparoscopic abdominoperineal resection for low rectal cancer

  • Jin-Tung LiangEmail author
  • Jason Chia-Hsien Cheng
  • Kuo-Chin Huang
  • Hong-Shiee Lai
  • Chia-Tung Sun
Dynamic Manuscript

Abstract

Background

By traditional open surgery, the tumor recurrence rate of total mesorectal excision with sphincter-preserving procedure was lower than that of abdominoperineal resection (APR) for the treatment of low rectal cancer. The present study aimed to rescrutinize whether the same conclusion can be drawn when both surgical procedures are performed laparoscopically.

Methods

We retrospectively reviewed the prospectively recorded clinicopathologic data of 344 consecutive patients with low rectal cancer, in which 170 patients underwent preoperative chemoradiotherapy followed by laparoscopic total mesorectal excision (TME), whereas 174 patients underwent laparoscopic TME directly without chemoradiotherapy. Such patients were further stratified according to the pathologic tumor, node, metastasis stage (stage II or III disease) and surgical strategy (APR or sphincter-preserving operation [SPO]). The surgical procedures are presented in supplemental videos. The disease-free survival, recurrence patterns, and functional recovery of patient groups stratified as appropriate were compared.

Results

In patients who received preoperative chemoradiotherapy, the estimated recurrence rate were similar between laparoscopic TME with SPO and laparoscopic APR with 10.6 %, 7 of 66, versus 18.5 %, 5 of 27, in stage II disease (p = 0.811, log-rank test); and 19.3 %, 11 of 57, versus 20 %, 4 of 20, in stage III disease (p = 0.980). In patients without preoperative chemoradiotherapy, the recurrence rate was significantly higher in laparoscopic APR than in the laparoscopic TME with SPO group of patients with stage III disease (45 %, 9 of 20, vs. 19.3 %, 16 of 83, p = 0.025), whereas the recurrence rate of the two procedures was similar (21.4 %, 3 of 14, vs. 17.5 %, 10 of 57, p = 0.702) in stage II disease.

Conclusions

When low rectal cancer was operated on by laparoscopic approach, the poorer prognosis of APR compared to SPO was only observed in stage III patients without preoperative chemoradiotherapy.

Keywords

Abdominoperineal resection (APR) Laparoscopic surgery Rectal cancer Sphincter-preserving operation (SPO) Total mesorectal excision (TME) 

Abbreviations

CCRT

Concurrent chemoradiation therapy

TME

Total mesorectal excision

SPO

Sphincter-preserving operation

Notes

Acknowledgments

This study was supported from National Science Council, Taiwan (NSC 96-2314-B-002-146) and Research Fund of Colorectal Cancer in National Taiwan University Hospital. The fund supported laboratory experiment and management of clinical data.

Disclosures

  Jin-Tung Liang, Jason Chia-Hsien Cheng, Kuo-Chin Huang, Hong-Shiee Lai, and Chia-Tung Sun have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 9829 kb)

Supplementary material 2 (MPG 10428 kb)

Supplementary material 3 (MPG 8889 kb)

Supplementary material 4 (MPG 10816 kb)

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jin-Tung Liang
    • 1
    Email author
  • Jason Chia-Hsien Cheng
    • 2
  • Kuo-Chin Huang
    • 3
  • Hong-Shiee Lai
    • 1
  • Chia-Tung Sun
    • 4
  1. 1.Division of Colorectal Surgery, Department of SurgeryNational Taiwan University Hospital, and College of MedicineTaipeiTaiwan
  2. 2.Department of Radiation OncologyNational Taiwan University Hospital, and College of MedicineTaipeiTaiwan
  3. 3.Department of Family MedicineNational Taiwan University Hospital, and College of MedicineTaipeiTaiwan
  4. 4.Department of PathologyNational Taiwan University Hospital, and College of MedicineTaipeiTaiwan

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