Laparoscopic ISR outcomes similar to open surgery for low rectal cancer
MedWire News: Laparoscopic intersphincteric resection (ISR) is a feasible option for treating patients with low rectal cancer, suggest study findings showing comparable long-term outcomes to open surgery with shorter hospital stay.
Christophe Laurent (University of Bordeaux, France) and co-authors retrospectively compared patients with a rectal tumor below 6 cm from the anal verge treated by open (n=65) or laparoscopic curative ISR (n=110).
Six weeks after radiotherapy, total mesorectal excision (TME) with intersphincter excision and protected low coloanal anastomosis was performed. Patients with T3, T4 or N+ tumors received long-course preoperative radiotherapy.
Patients in both groups were similar in terms of age, gender, body mass index, patient American Society of Anesthesiologists score, tumor characteristics, and postoperative chemotherapy.
Compared with conventional laparotomy, use of the laparoscopic approach for ISR resulted in similar mortality (0%) and morbidity (28% and 23%, respectively), but was associated with a shorter duration of hospital stay (16 vs 9 days, respectively). Furthermore, rates of pelvic sepsis after laparoscopic and open ISR did not differ significantly, at 20% and 25%, respectively.
"Although these data show the safety of the laparoscopic approach for ISR, the complication rate is high in both groups… Shortening the duration of the procedure [from 4 hours] might reduce morbidity," write the authors in the journal Colorectal Diseases.
"Careful patient selection is also crucial," they add.
After a median 53 months of follow-up, no differences were seen in 5-year local recurrence between laparoscopic and open ISR (5% and 2%, respectively), distant recurrence (24% and 19%), overall survival (85% and 82%), and disease-free survival (70% and 71%).
No difference in stool frequency, fragmentation, urgency, and anal continence were observed between the two groups.
"The good long-term oncologic results observed in the present study may be due to the specialization of the surgeons in both TME and laparoscopic colorectal surgery," say Laurent et al.
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By Ingrid Grasmo