Clinical Outcome of Laparoscopic Intersphincteric Resection Combined with Transanal Rectal Dissection for T3 Low Rectal Cancer in Patients with a Narrow Pelvis
Purpose. The purpose of this study was to analyze the safety and feasibility of laparoscopic intersphincteric resection (ISR) combined with transanal rectal dissection (TARD) for T3 low rectal cancer in a narrow pelvis. Methods. We studied 20 patients with a narrow pelvis of median body mass index 25.3 (16.9–31.2). Median observation period was 23.6 months (range 12.2–56.7). Results. Partial, subtotal, and total ISR was performed in 15, 1, and 4 patients, respectively. Median duration of TARD was 83？min (range 43–135). There were no major complications perioperatively or postoperatively. Surgical margins were histologically free of tumor cells in all patients, and there was no local recurrence. Excluding urgency, frequency of bowel movements, and incontinence status improved gradually after stoma closure. Conclusion. Laparoscopic ISR combined with TARD is technically feasible for selective T3 low rectal cancer in patients with a narrow pelvis. 1. Introduction Intersphincteric resection (ISR) to preserve anal sphincter function for low rectal cancer extending into the anal canal was reported by Schiessel et al. in 1994 [1]. The feasibility of ISR has been demonstrated by surgeons since that time; it is now technically possible to use ISR to remove low rectal cancer with preservation of anal sphincter function with a satisfactory oncologic outcome [2, 3]. Recently, the clinical outcome of ISR as a laparoscopic approach (laparoscopic ISR) has been reported, but laparoscopic ISR for patients with bulky low rectal cancer remains challenging. Particularly for T3 tumors in patients with a narrow pelvis, it is important to achieve a low local recurrence. Total mesorectal excision (TME), negative circumferential margin (CFM), and tumor free surgical margin are prerequisites regardless of approach of ISR. Conversion to open operation in laparoscopic ISR may influence prognosis, as is the case in laparoscopic surgery for rectal cancer [4]. We have shown that transanal rectal dissection (TARD) performed prior to the abdominal phase of the operation is very useful for an adequate oncologic resection in laparoscopic ISR for T3 low rectal cancer in patients with a narrow pelvis [5]. The purpose of this report is to evaluate the safety and feasibility of TARD to achieve laparoscopic ISR for T3 low rectal cancers in patients with a narrow pelvis. 2. Patients Preoperative staging evaluation included digital rectal examination, barium enema, colonofiberscope with biopsy, computed tomography (CT), magnetic resonance imaging (MRI), and transanal ultrasound (TAUS). The
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