Laparoscopic Versus Open Approach for Intersphincteric Resection—Results from a Tertiary Cancer Center in India

Abstract

The study aims to compare open intersphincteric resection (OISR) with laparoscopic intersphincteric resection (LISR) in terms of short-term oncological and clinical outcomes. This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent intersphincteric resection (ISR) at Tata Memorial Centre between 1st July 2013 and 30th November 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), distal resection margin involvement, and number of nodes harvested. Perioperative outcomes included blood loss, length of hospital stay and 30-day postoperative morbidity and mortality. Chi-square test was used to compare the results between the two groups. Thirty nine cases of OISR and 34 cases of LISR were included in the study. Median BMI was higher in LISR group; otherwise, the two groups were comparable in all aspects. There were no conversions in LISR group. CRM involvement was seen in four patients (10%) in the conventional group compared to none in the LISR group. Median hospital stay was comparable between the two groups. Laparoscopic ISR is safe and can be performed with low conversion rate in selected group of patients.

Laparoscopic versus open resection in locally advanced rectal cancers: a propensity matched analysis of oncological and short‐term outcomes

“…The pCRM was considered positive if the tumour was present at or within 1 mm from the inked resection margins [22]. Anastomotic leakage was defined clinicoradiologically as the presence of faeculent discharge in the drain or radiological evidence of spillage of contrast from the anastomotic site or any peri-anastomotic collection requiring drainage [17].…”

“…With the high volume of rectal cancers presenting to the colorectal unit, rigorous multidisciplinary team (MDT) evaluation and regular MRI use, our surgical practice has evolved significantly. This enables us to offer laparoscopic resections even for high-risk locally advanced rectal cancers [17][18][19][20]. However, considering the concerns raised in recent trials [6,7] about the oncological safety of laparoscopic rectal cancer surgery and the different tumour profile seen in our centre, it was necessary to analyse our practice critically.…”

Review of Intersphincteric Resections for Rectal Cancer Treatment

“…Peritoneal disease and liver metastasis are a sign of advanced metastatic disease. Our recent publication details our experience with a laparoscopic approach, but the operative steps summarized below apply to both open and laparoscopic procedures for ISR [18].…”

Robotic transabdominal intersphincteric resection and coloanal anastomosis with the da Vinci Xi System – a video vignette

“… and has been refined in successive years . Laparoscopic ISR has been shown to be technically feasible with acceptable functional and oncological outcomes . Robotic systems have shown a distinctive advantage to overcome the technical challenges of accurate dissection in the anatomical constraints of the pelvis because of features such as high‐definition three‐dimensional (3D) vision, 7 degrees of freedom and tremor filtering, amongst others.…”