Evaluation of Laparoscopic Sphincter Saving Surgery in Management of Rectal Cancer

Abstract

Background: Sphincter-saving surgery for rectal carcinoma (RC) has been classically performed by open surgery. Laparoscopic restorative proctectomy (LRP) has been evolved for the same purpose, but its benefits are controversial representing an enigma in the choice of management of RC.
Objective: The aim of this study was to evaluate the feasibility, adequacy, safety, short- and long-term outcomes of LRP.
Patients and methods: This was a prospective observational study included 35 patients suffering from middle and distal third RC admitted electively to Sohag University Hospital and Colorectal Unit in Ain Shams University. Patients were evaluated and analysed regarding efficacy of LRP, length of stay and different risk factors for post-operative complications.
Results: Regarding operative outcomes the mean operative time was 189 minutes, and mean operative blood loss was 95.4 mL, while operative complications happened in 8.5%. Post-operatively, complications happened in 22.9%. The mean post-operative hospital stay was 4.2 ± 1.4 days. Higher American Society of Anesthesiologists (ASA) risk scoring and advanced pathological stage proved to be independent risk factors responsible for complications. During follow-up, local recurrence was evident in 5.7% and distant recurrence developed in further 5.7%. Disease-free survival rate was 80.02 %, and overall survival rate was 91.3% for stage II and 83.3% for stage III.
Conclusion: LRP can be done safely reflecting adequacy of the procedure with a comparable complication rate and long-term outcomes to conventional surgery, which makes it a good alternative to conventional technique.