Feasibility of Laparoscopic Intersphincteric Resection for Patients with cT1-T2 Low Rectal Cancer

Shiomi, Akio; Kinugasa, Yusuke; Yamaguchi, Takahiro; Tsukamoto, Syunsuke; Tomioka, Hiroyuki; Kagawa, Hiroyasu

doi:10.1159/000354034

Cited by 15 publications

(7 citation statements)

References 25 publications

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“…[ 9 , 10 ] Laparoscopic surgery has been reported to improve postoperative short-term effects, with faster recovery and shorter hospital stay. [ 11 – 14 ] But there are many reports of laparoscopic CRC surgery that had a high degree of difficulty especially in low and super-low rectal cancers and postoperative complications and high port recurrence, [ 15 , 16 ] so its superiority and safety are still controversial.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma

Tong¹,

Gao²,

Liu³

et al. 2017

Medicine

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Objective:The aim of this article is to study the superiority and safety of laparoscopic surgery for colorectal carcinoma.Summary Background Data:Laparoscopy in rectal cancer is still not recommended as the treatment of choice by National Comprehensive Cancer Network guidelines. Laparoscopic rectal surgery is more complex and technically demanding, especially for mid and low rectal cancer.Methods:A computer-based online research of retrospective or prospective studies addressing laparoscopic surgery versus conventional open surgery for colorectal carcinoma published in the last 11 years was performed in electronic database (Wangfang Database, China National Knowledge Infrastructure, Chinese Medical Current Contents, Pubmed, Medline, Ovid, Elsevier, ISI Web of Knowledge, Cohrane Database of Systematic Reviews). Selective trials were analyzed by the Review Manager 5.2 software.Results:A total of 9 clinical trials, involving a total of 4747 patients, were identified. A meta-analysis showed that operating time was not significantly different between the 2 groups [WMD = 0.46, 95% confidence interval (95% CI): −55.68 to 56.60, P = .99], intraoperative blood loss in laparoscopic surgery group was less than conventional open surgery group (WMD = −64.66, 95% CI: −87.31 to 42.01, P < .01); No significant difference in the number of lymph node retrieved from postoperative pathologic specimens was found between the 2 groups (WMD = −0.75, 95% CI: −1.72 to 0.23, P = .14); Postoperative time to flatus in laparoscopic surgery group was earlier than that in open surgery significantly (WMD = −1.22, 95% CI: −1.53 to −0.91, P < .01). The cases of postoperative complications were significantly different between the 2 groups, which showed that the cases of laparoscopic surgery group were less than those of open surgery group [odds ratio (OR) = 0.62, 95% CI: 0.52∼0.72, P < .01]; Moreover, hospital stay of laparoscopic surgery group was shorter than that of open surgery that showed significant difference (WMD = −2.38, 95% CI:−3.30 to −1.46, P < .01).Conclusion:Short-term outcomes of laparoscopic surgery are superior than conventional open surgery that include more safety and feasibility, and is expected to be a standardization operation method for colorectal carcinoma.

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Section: Introductionmentioning

confidence: 99%

A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma

Tong¹,

Gao²,

Liu³

et al. 2017

Medicine

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“…furthermore, with the progress of laparoscopic techniques, some surgeons now perform isR endoscopically. [10][11][12][13] During endoscopic surgery, structures in the deep pelvic region can be observed more clearly and at greater magnification than they can during open surgery. During endoscopic isR, the attachment of the lam to the rectum and the intersphincteric space can be seen very clearly from the abdominal approach, and it becomes possible to more precisely select a surgical line; however, the optimal surgical line in this area remains undefined.…”

mentioning

confidence: 99%

Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease

Tsukada

Ito

Watanabe

et al. 2016

Diseases of the Colon &Amp; Rectum

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The levator ani muscle attaches directly to the longitudinal muscle of the rectum. The spatial relationship between the smooth and skeletal muscles differed in different portions of the anal canal. For intersphincteric resection, dissection must be performed between the longitudinal muscle of the rectum and the levator ani muscle/external anal sphincter, and the appropriate surgical lines must be selected based on the specific structural characteristics of each portion.

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“…The institutional standard surgical procedure has been described elsewhere [22][23][24]. The surgical procedure was almost the same in both LAR and ISR up to dividing the rectum.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

Kojima

Hino

Shiomi

et al. 2021

Preprint

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Background Sphincter-preserving operations for ultra-low rectal cancer include low anterior resection and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is performed. We aimed to evaluate whether robotic-assisted surgery is technically superior to laparoscopic surgery for ultra-low rectal cancer. The frequency of conducting low anterior resection by a specific procedure can indicate the technical superiority of that procedure for ultra-low rectal cancer. Thus, we compared the frequency of low anterior resection between robotic-assisted and laparoscopic surgery in cases of sphincter-preserving operations. Methods We investigated 183 patients who underwent sphincter-preserving robotic-assisted or laparoscopic surgery for ultra-low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic-assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic-assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was performed significantly more frequently in robotic-assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (p = 0.04). Multivariate analyses showed that tumor distance from the anal verge (p < 0.01) and robotic-assisted surgery (p = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusions Compared with laparoscopic surgery, robotic-assisted surgery significantly increased the frequency of low anterior resection in sphincter-preserving operations for ultra-low rectal cancer. Robotic-assisted surgery has technical superiority over laparoscopic surgery for ultra-low rectal cancer treatment.

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Feasibility of Laparoscopic Intersphincteric Resection for Patients with cT1-T2 Low Rectal Cancer

Cited by 15 publications

References 25 publications

A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma

A meta-analysis of short-term outcome of laparoscopic surgery versus conventional open surgery on colorectal carcinoma

Topographic Anatomy of the Anal Sphincter Complex and Levator Ani Muscle as It Relates to Intersphincteric Resection for Very Low Rectal Disease

Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

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