LAPAROSCOPIC ABDOMINOPERINEAL EXCISION OF THE RECTUM

In laparoscopic abdominoperineal resection of the rectum (LAP-AP) an a bdominal incision is completely avoided as the tumor is delivered thro ugh the perineal incision. It is our belief that the view provided in the pelvis by laparoscopy is significantly better than at laparotomy a nd allows excellent anatomical definition and meticulous dissection. I n this study we compared the adequacy of excision of the first 12 pati ents undergoing LAP-AP to the last 16 patients undergoing open abdomin operineal resection (OP-AP). In all patients the procedure was carried with curative intent for adenocarcinoma and the Dukes staging and Jas s score's were similar in both groups. GRAPHICS The data demonstrate s imilar nodal harvest in both groups as well as extent of radial excisi on, However, two patients in the open group had microscopic radial mar gin involvement despite being macroscopically clear at surgery. We con clude that although long-term follow-up is required to address the iss ue of local cancer recurrence, laparoscopic rectal dissection appears as good as open surgery and may allow a more precise assessment of exc ision margins.