INTRODUCTION: Laparoscopic abdominoperineal resection (LAPR) as a minimally invasive approach for the treatment of large rectal cancer is widely used. It has been proven to be technically feasible and safe with fewer complications and faster postoperative recovery than the open procedure. Our aim was to evaluate LAPR safety and feasibility as compared to the open procedure in large low rectal cancer.
PATIENTS AND METHODS: A total of 34 low rectal cancer patients who underwent open APR (OAPR) were matched with 42 patients who underwent LAPR in a one-to-one fashion between 2011 and 2014 in the Division of General Surgery, Kaspela University Hospital of Plovdiv.
RESULTS: Intraoperative parameters of LAPR were better than those of OAPR as followed: mean operation time (121.8±47.8 min versus 152.1±49.2 min), mean operative blood loss (82±30.0 mL versus 120±35.0 mL), mean total number of retrieved lymph nodes (12±1 versus 12±1.4), and percentage of surgical complications (12.3% versus 15.1%). Laparoscopically treated patients showed significantly shorter postoperative analgesia (2.1±0.7 days versus 3.7±0.6 days), earlier first flatus (36.3±7.9 hours versus 48.5±9.2 hours), shorter urinary drainage (3.8±3.4 days versus 5.8±1.3 days), and shorter hospital stay (6.2±1 days versus 8±2.0 days). Local recurrence rate during a three-year period (in 3 versus 4 patients) and metachronous liver metastasis (in 5 versus 6 patients) were less common after LAPR than after OAPR.
CONCLUSION: The risks of APR-specific surgical complications such as perineal wound infection and parastomal hernia were comparable between the laparoscopic and open surgery groups. There were no significant differences regarding local recurrence and metachronous liver metastasis between these groups. Complication and locoregional recurrence rates in low large rectal cancer patients after laparoscopic and open were quite similar. Scr Sci Med 2017; 49(3): 22-26
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