Early experience with laparoscopic abdominoperineal resection.
BACKGROUND
Laparoscopic abdominoperineal resection (LAPR) has not been fully evaluated as a technique in the treatment of rectal and anal cancer or inflammatory bowel disease. The purpose of our study was to evaluate the early experience with laparoscopic abdominoperineal resection at Washington University Medical Center.


METHODS
A prospective analysis was performed on the first 21 patients undergoing the procedure at Washington University Medical Center. Indications for surgery included rectal cancer (14 patients), anal squamous cell cancer (four patients), inflammatory bowel disease (two patients), and anal melanoma (one patient).


RESULTS
The procedure was converted to open procedure in four patients (19%). The mean (+/-SEM) operative time and blood loss for completed and converted LAPR were 239 +/- 11 min and 424 +/- 43 ml, respectively. Postoperative hematocrit dropped a mean of 8.3% +/- 1.2% SEM; five patients required blood transfusion (24%). Wound complication occurred in four patients (19%; three perineal, one trocar site). Bowel function returned after a mean of 3 days, and mean postoperative hospital stay for the completed LAPR group was 5 days. Mild pain was experienced by 81% of patients (17/21) while 19% (4/21) noted moderate pain, usually of the perineal wound. The mean duration of patient-controlled analgesia use was 2 days. During the 1-44-month follow-up, six patients (29%) died from cancer (stage III or IV at operation) and only one patient developed local recurrence in the pelvis (5%). There were no trocar-site implants of cancer. Furthermore, there was no relationship between prior abdominal operations, the amount of blood loss, postoperative drop of hematocrit, or blood transfusion requirement and the length of hospitalization or complication rates.


CONCLUSIONS
Laparoscopic abdominoperineal resection is a feasible alternative to the conventional open technique in both cancer and colitis patients.
Wu
J S
JS
Section of Colon and Rectal Surgery, Department of Surgery, Jewish Hospital, Washington University School of Medicine, 216 S. Kingshighway, St. Louis, MO 63110, USA.
Birnbaum
E H
EH
Fleshman
J W
JW
D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001005:Anus Neoplasms / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012004:Rectal Neoplasms / Q000601:surgery; D016896:Treatment Outcome