title: Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer: surgical feasibility and intermediate-term outcome.
abstract: BACKGROUND
  Traditionally, conventional intersphincteric resection requires a combined abdominal and perineal approach and a handsewn coloanal anastomosis procedure, which is difficult to accomplish via the perineal approach. A completely abdominal approach partial intersphincteric resection (APISR) with laparoscopy can simplify the anastomosis procedure. This study evaluated the intermediate-term oncological and functional results of laparoscopic versus open APISR for low rectal cancer.
  
  
  METHODS
  A total of 137 consecutive patients with low rectal cancer who underwent APISR from January 2006 to August 2013 were retrospectively evaluated. Patient groups were classified into as open surgery (OP, n = 48) group and laparoscopy (LAP, n = 89). The primary endpoint was 3-year disease-free survival and the Wexner score for anal function.
  
  
  RESULTS
  The LAP group had longer operating time, less intraoperative blood loss, and shorter hospital stay after surgery compared with the OP group. Median follow-up was 32.3 months. The local recurrence rates were similar in the two groups (LAP 3.2% vs. OP 6.1%; P = 0.652). The combined 3-year disease-free survival rate was 83.2% in the LAP group and 83.8% in the OP group (P = 0.857). Wexner scores were similar in the two groups (LAP 2.9 ± 4.5 vs. OP 3.1 ± 5.0). In the LAP group, 89.7% of patients had good continence compared with 91.4% in the OP group (P = 0.311).
  
  
  CONCLUSIONS
  Laparoscopic APISR can be performed safely and offers similar intermediate-term oncological and functional outcome compared with the open procedure. The oncological adequacy requires long-term follow-up data.
authors.affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, People's Republic of China, cp3169@163.com.
authors.forename: Pan
authors.initials: P
authors.lastname: Chi
authors.forename: Sheng-Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Lin
authors.forename: Xing-Rong
authors.initials: XR
authors.lastname: Lu
authors.forename: Ying
authors.initials: Y
authors.lastname: Huang
authors.forename: Wei-Zhong
authors.initials: WZ
authors.lastname: Jiang
authors.forename: Zong-Bin
authors.initials: ZB
authors.lastname: Xu
authors.forename: Zhi-Fen
authors.initials: ZF
authors.lastname: Chen
authors.forename: Yan-Wu
authors.initials: YW
authors.lastname: Sun
authors.forename: Dao-Xiong
authors.initials: DX
authors.lastname: Ye
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate