Laparoscopic vs. open abdominoperineal resection for cancer

PURPOSE: The aim of this study was to compare the safety and efficacy of la paroscopic abdominoperineal resection and open abdominoperineal resection f or cancer. METHODS: Records of 194 patients who underwent laparoscopic abdo minoperineal resection (42 patients) or open abdominoperineal resection (15 2 patients) at three institutions betw een 1991 and 1997 were reviewed. Fol low-up was through office charts, American College of Surgeons cancer regis try, or telephone contact. Tumors included (laparoscopic abdominoperineal r esection and open abdominoperineal resection, respectively) adenocarcinoma (86 and 92 percent), squamous (12 and7 percent), and gastrointestinal strom al (2 and 1.4 percent) types; Stages I (17 and 26 percent), II (24 and 33 p ercent), III (43 and 32 percent), and IV (14 and 9 percent); and those with invasion of pelvic structures (14 and 16 percent). RESULTS: Laparoscopic a bdominoperineal resection was converted to open abdominoperineal resection in 21 percent because of vessel injury (33 percent), poor exposure (22 perc ent), adhesions (22 percent), inguinal hernia (11 percent), or radiation fi brosis (11 percent). Perineal infections occurred more often in the laparos copic abdominoperineal resection group (24 vs. 8 percent; P = 0.02). Late s toma complications were similar. Mean hospital stay was shorter after lapar oscopic abdominoperineal resection (7 vs. 12 days). Radial margins were pos itive in 12 percent of laparoscopic abdominoperineal resection and 12.5 per cent of open abdominoperineal resection specimens. Tumor recurrence was sim ilar for both local (19 and 14 percent) and distant (38 and 26 percent) rec urrence. Survival rates were similar by Kaplan-Meier curves, with median fo llow-up of 19 and 24 months, respectively (P = 0.22; log rank). CONCLUSION: Laparoscopic abdominoperineal resection can be performed safely and result s in a shorter hospital stay. A randomized, prospective trial is needed to determine the long-term outcome of cancer treatment.