CHU Bordeaux, Saint André Hospital, Department of Digestive Surgery, Bordeaux, France Université Victor Segalen Bordeaux 2, Bordeaux, France.
Colorectal Dis. 2012 Jan;14(1):35-41; discussion 42-3. doi: 10.1111/j.1463-1318.2010.02528.x.
Laparoscopic sphincter-saving surgery has been investigated for rectal cancer but not for tumours of the lower third. We evaluated the feasibility and efficacy of laparoscopic intersphincteric resection for low rectal cancer.
From 1990 to 2007, patients with rectal tumour below 6 cm from the anal verge and treated by open or laparoscopic curative intersphincteric resection were included in a retrospective comparative study. Surgery included total mesorectal excision with internal sphincter excision and protected low coloanal anastomosis. Neoadjuvant treatment was given to patients with T3 or N+ tumours. Recurrence and survival were evaluated by the Kaplan-Meier method and compared using the Logrank test. Function was assessed using the Wexner continence score.
Intersphincteric resection was performed in 175 patients with low rectal cancer: 110 had laparoscopy and 65 had open surgery. The two groups were similar according to age, sex, body mass index, ASA score, tumour stage and preoperative radiotherapy. Postoperative mortality (zero) and morbidity (23%vs 28%; P = 0.410) were similar in both groups. There was no difference in 5-year local recurrence (5%vs 2%; P = 0.349) and 5-year disease-free survival (70%vs 71%; P = 0.862). Function and continence scores (11 vs 12; P = 0.675) were similar in both groups.
Intersphincteric resection did not alter long-term tumour control of low rectal cancer. The safety and efficacy of the laparoscopic approach for intersphincteric resection are suggested by a similar short- and long-term outcome as obtained by open surgery.
腹腔镜肛门保留手术已被用于直肠癌的治疗，但尚未应用于下段直肠癌的治疗。本研究旨在评估腹腔镜经肛门内括约肌间切除术治疗低位直肠癌的可行性和疗效。
回顾性对比研究纳入了 1990 年至 2007 年间接受经肛门内括约肌间切除术（直肠肿瘤距肛缘 6cm 以内）治疗的直肠癌患者。手术方法为全直肠系膜切除术，包括内括约肌切除和保护性低位结肠直肠吻合。T3 或 N+的患者给予新辅助治疗。采用 Kaplan-Meier 法评估复发和生存情况，并采用 Logrank 检验进行比较。采用 Wexner 失禁评分评估功能。
175 例低位直肠癌患者接受了经肛门内括约肌间切除术：110 例行腹腔镜手术，65 例行开腹手术。两组患者在年龄、性别、体重指数、ASA 评分、肿瘤分期和术前放疗方面无显著差异。两组患者的术后死亡率（0 例）和发病率（23%对 28%；P=0.410）无显著差异。两组患者的 5 年局部复发率（5%对 2%；P=0.349）和 5 年无病生存率（70%对 71%；P=0.862）无显著差异。两组患者的功能和失禁评分（11 分对 12 分；P=0.675）也无显著差异。
经肛门内括约肌间切除术并未改变低位直肠癌的长期肿瘤控制效果。本研究结果提示，与开腹手术相比，腹腔镜经肛门内括约肌间切除术具有相似的短期和长期疗效，是一种安全有效的手术方法。
