Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, 160 ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanamdo, 519-809, Korea.
World J Surg. 2011 Dec;35(12):2811-7. doi: 10.1007/s00268-011-1277-2.
Laparoscopic intersphincteric resection (ISR) after neoadjuvant chemoradiation is helpful in the management of patients with low rectal cancer. With the advent of this technique, the need for performance of abdominoperineal resection seems to have decreased in patients with very low rectal tumors. The aim of the present study was to evaluate the feasibility, the functional outcome, and the short-term oncologic outcomes of laparoscopic ISR for low rectal adenocarcinoma at our institution.
We retrospectively reviewed the data of 111 consecutive patients who underwent laparoscopic ISR for low rectal adenocarcinoma between July 2005 and December 2009. Demographic status, surgical outcomes, functional outcome data, and oncologic outcome data were collected.
The mean distance of the tumor from the anal verge was 3.4 cm (range: 1-5 cm). The mean operative time was 214.7 min (range, 150-450 min). The mean distal resection margin was 1.3 ± 1.1 cm. Morbidity occurred in 24 patients (21.6%), including anastomotic leakage in 2 patients (1.8%). The mean Wexner continence score after stoma repair was 7.5 ± 2.7 (range: 2 ~ 19), and 9.8 in total ISR, 7.3 in partial ISR (P = 0.071). The 3-year overall survival rate was 92.8%, and the 3-year disease-free survival rate was 73.0%. Local recurrence was noted in 6 of the 111 patients with TNM stage I to III (5.4%). The patients with lesions at 2 cm to the dentate line had a 7.07-fold greater risk of local recurrence, including a 13.42-fold greater risk of lateral pelvic wall recurrence and perineal recurrence (95% Confidence interval [CI], 1.141-158.006; P = 0.009) than in those who had lesions more than 2 cm from the anal verge (95% CI, 1.290-38.832; P = 0.011).
Laparoscopic ISR after neoadjuvant chemoradiation can be recommended as a technically feasible, minimally invasive, and a sphincter-saving procedure with acceptable functional and short-term oncologic outcomes in patients with very low rectal cancer.
新辅助放化疗后腹腔镜经肛门内括约肌切除术（ISR）有助于低位直肠癌患者的治疗。随着该技术的出现，低位直肠肿瘤患者施行腹会阴联合切除术的需求似乎有所减少。本研究旨在评估我们机构对低位直肠腺癌行腹腔镜 ISR 的可行性、功能结果和短期肿瘤学结果。
我们回顾性分析了 2005 年 7 月至 2009 年 12 月期间 111 例连续接受腹腔镜 ISR 治疗的低位直肠腺癌患者的数据。收集人口统计学状态、手术结果、功能结果数据和肿瘤学结果数据。
肿瘤距肛缘的平均距离为 3.4 cm（范围：1-5 cm）。平均手术时间为 214.7 分钟（范围：150-450 分钟）。平均远端切缘为 1.3 ± 1.1 cm。24 例（21.6%）患者发生并发症，包括 2 例（1.8%）吻合口漏。造口修复后平均 Wexner 控便评分 7.5 ± 2.7（范围：2-19），总 ISR 为 9.8，部分 ISR 为 7.3（P = 0.071）。3 年总生存率为 92.8%，3 年无病生存率为 73.0%。111 例 TNM Ⅰ至Ⅲ期患者中有 6 例（5.4%）局部复发。齿状线 2 cm 以内的病变患者局部复发的风险增加 7.07 倍，包括侧盆壁和会阴复发的风险增加 13.42 倍（95%置信区间[CI]：1.141-158.006；P = 0.009），而距肛缘 2 cm 以上的病变患者局部复发的风险增加 7.07 倍（95%CI：1.290-38.832；P = 0.011）。
新辅助放化疗后腹腔镜 ISR 可作为一种技术上可行的微创、保肛手术，在低位直肠癌患者中具有可接受的功能和短期肿瘤学结果。
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