Art Hiranyakas1, Yik-Hong Ho. 1. Department of Surgery, James Cook University, IMB 52, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queeensland 4811, Australia. art.hiranyakas@jcu.edu.au
Abstract
BACKGROUND: Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes. METHODS: Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected. RESULTS: There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy (P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date. CONCLUSIONS: The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results.
BACKGROUND: Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes. METHODS: Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected. RESULTS: There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy (P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date. CONCLUSIONS: The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results.