Abstract: Objective:To investigate the surgical techniques and clinical efficacy of laparoscopic intersphincteric resection(ISR) in the treatment of low rectal cancer.
Methods:A retrospective descriptive study was performed. The clinical data of 12 patients who underwent laparoscopic low rectal anterior resection combined with ISR at the First Affiliated Hospital of Dalian Medical University from May 2014 to October 2014 were collected. The patients underwent abdominal operation including total mesorectal excision (TME)+sphincter mobilization, then transanal intersphincteric resection, finally colinic analanal anastomosis. The operation time, volume of intraoperative blood loss, number of lymph node dissected, postoperative complications, time to anal exsufflation, duration of hospital stay, duration of postoperative hospital stay, pathological stage and followup were observed. The patients were followed up by outpatient examination and telephone interview at month 1, 3 and 6 after operation up to April 18, 2015. The followup included the prognosis of patients and the recovery of anal function. The function of defecation was evaluated by Wexner scoring system and Kirwan grading. Measurement data with normal distribution were presented as ±s.
Results:All the 12 patients were completed laparoscopic surgery without conversion to open surgery. Eight patients underwent partial internal anal sphincter resection, and 4 underwent subtotal resection. Four patients in T3 stage underwent lateral lymph node dissection preserving the left colonic artery, hypogastric nerve and pelvic nerve. The operation time was (290±35) minutes. The volume of intraoperative blood loss was (124±80)mL. The number of lymph nodes dissected was 17±8, and the number of positive lymph nodes was 0-4. The distance of the distal margin was (2.0±0.5)cm, and the margin was negative. All the 12 patients were not complicated with infection, bleeding, anastomotic leakage, anastomotic stenosis and other complications. The time to postoperative anal exsufflation was (3±1)days, duration of hospital stay was (20±3)days, and duration of postoperative hospital stay was (12±3)days. The results of TNM stage showed 3 cases of pT1 stage, 5 cases of pT2 stage, 4 cases of pT3 stage, 10 cases of pN0 stage, 1 case of pN1 stage, 1 case of pN2 stage, 8 cases ofⅠstage, 2 cases of Ⅱstage and 2 cases of Ⅲ stage. All the 12 patients were followed up for 6-11 months. The defection frequency and the Wexner score at month 1, 3 and 6 after  operation were 12±7, 15±3, 9±5 and 13±4, 5±3, 10±3, respectively. Of the 12 patients, the number of patients with satisfactory Kirwan score, flatus incontinence and loose stool was 1, 3, 8 at month 1 after operation, 3, 3, 6 at month 3 after operation, 10, 2, 0 at month 6 after operation, respectively.
Conclusion Laparoscopic ISR is effective in the treatment of low rectal cancer.