Laparoscopic Versus Open Total Mesorectal Excision With Anal Sphincter Preservation For Low Rectal Cancer: A Randomized Trial On Short-term Outcome

AIM: To assess the feasibility and efficacy of laparoscopic total mesorectal excision (TME) with anal sphincter preservation (ASP) for low rectal cancer by comparing the relative data with open procedure.METHODS: Between June 2001 and September 2002, 130 patients with low rectal cancer underwent total mesorectal excision with anal sphincter preservation, 63 by laparoscopic procedure and 68 by open technique. The lowest margin of tumors was below peritoneal reflection and 1.5~8cm above the dentate line (1.5~4cm in 84 cases, 5~8cm in 46 cases). The grouping was randomized.RESULTS: Results of operation, post-operative recovery and short term oncological follow-up were compared between 62 laparoscopic procedures (1 was converted to open procedure) and 68 controls who underwent open surgery during the same observation period, there was 100% sphincter preservation rate. TME and ASP were accomplished on all the patients. Inlaparoscopic group, 23 patients in low anterior resection had the level of the anastomosis below peritoneal reflection and above 2cm from the dentate line; 22 patients in ultralow anterior resection had anastomotic height below 2cm from the dentate line; and 17 patients in coloanal anastomoses had the level of the anastomosis at/below the dentate line; in the open group the numbers were 25,24, and 19. The respective mean operating times of laparoscopic and open procedure were 125 minutes (range, 110-210) and 120 minutes (range, 90-240ml)(p>0.05), while the mean operative blood loss was 20ml (range,5-80ml) and 87ml (range,50-200ml) (p<0.05). There was no significant difference in the use of parenteral analgesics and the start of food intake between two groups. However, after laparoscopic resection the return of bowel function was earlier and hospitalization time was shorter. There were no statistical differences in survival, recurrence and cancer related mortality between the two groups, and no port-site recurrence was found in patients who underwent laparoscopic TME with ASP.CONCLUSION: The short term follow-up showed that there was no significant difference in oncological outcome between the laparoscopic and open techniques. However, totally laparoscopic TME with ASP is a perspective minimally invasive technique with the benefits of much lower blood loss in operation, more accurate autonomic nerve preservation, higher rate of sphincter preservation, earlier return of bowel function and shorter hospitalization.