Laparoscopic abdominoperineal resection - Early postoperative results of aprospective study involving 116 patients

PURPOSE: Although laparoscopic colorectal surgery is attracting ever more a ttention, its use for curative treatment of colorectal carcinoma in particu lar continues to be controversial. The present study was an attempt to anal yze the results of the perioperative course, oncologic quality, and prelimi nary long-term results. METHOD: The data considered here were collected wit hin the framework of a prospective, observational study initiated on August 1, 1995, and involving a total of 18 institutions in Germany and Austria. At the end of three years, the results are now being presented selectively, i.e., focusing only on abdominoperineal resection. RESULTS: A total of 116 patients underwent laparoscopic abdominoperineal resections, 98 (84.5 per cent) of which were performed with curative intent. The mean operating time was 226 (confidence interval, 140-365) minutes. Seven patients (6 percent) experienced an intraoperative complication, which in more than one-half of the cases was a vascular injury involving the presacral venous plexus; the conversion rate was 3.4 percent. Postoperatively, 40 patients developed 97 complications-including those of a very minor nature-giving an overall mor bidity rate of 34.4 percent. Reoperation in six patients (5.2 percent) had to be performed for an afterbleed in one-half of the cases and ileus in the other one-half. Postoperative mortality was a low 1.7 percent. In most of the curative resections, an oncologically radical operation with high trans ection of the inferior mesenteric artery and a complete dissection of the p elvis down to the floor was performed. The median number of lymph nodes inv estigated was 11.5, and there was wide fluctuation in the numbers among the individual institutions. Tumor cell dissemination occurred intraoperativel y in five patients. In the meantime, 79 patients (81 percent) underwent at least one follow-up examination, the mean follow-up period being 491 days. Seven patients developed a local recurrence, and a further six patients dev eloped distant metastases. For recurrence-free survival rate, the Kaplan-Me ier estimation calculated a probability of 71 percent. CONCLUSION: Not all of the reservations about laparoscopic abdominoperineal resection, in parti cular with regard to resection with curative intent, have yet been eliminat ed. The present study does, however, show that a laparoscopic approach can in principle meet oncologic requirements of radicality and, with regard to the postoperative course, is associated with considerable benefits to the p atient.