Application of laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal cancer

Abstract

This study aimed to investigate the influence of laparoscopic total mesorectal excision combined with sphincter-preserving surgery on the postoperative defecation function, urinary function and sexual function in low or ultralow rectal cancer. A retrospective study was undertaken on 107 patients (65 laparoscopic resection and 42 laparoctomic resection) with rectal cancer undergoing laparoscopic or open laparoscopic total mesorectal excision combined with sphincter-preserving surgery from April 2009 to April 2013. The quality of life outcomes of all patients, including defection, urinary and sexual function, were assessed at 6, 12 and 24 months after operation. Gastrointestinal quality of life index (GQOLI) was used to evaluate the fecal incontinence and bowel dysfunction. Urinary and sexual functions were studied by means of questionnaires on the basis of the international prostatic symptom score (IPSS) and international index of erectile function (IIEF), respectively. In laparoscopic surgery group, there were two cases of anastomotic leakage, three cases of anastomotic stricture, seven cases of local recurrence, ten cases of hepatic metastasis and five cases of lung metastasis. The satisfaction rates of patients about their defecation function reached 60.3% (35/58, 84.5% (49/58) and 91.3% (53/58) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 10.7% (7/65); Among male patients, 18.4% (7/36) suffered from erectile dysfunction and 27.8% (10/36) suffered from ejaculatory dysfunction; 65.5% (19/29) female patients investigated were satisfied with their postoperative sexual life. In open surgery group, there were two cases of anastomotic leakage, two cases of anastomotic stricture, nine cases of local recurrence, ten cases of hepatic metastasis and seven cases of lung metastasis. The satisfaction rates of patients about their defecation function were 56.4% (22/39), 82.1% (32/39) and 94.8% (37/39) at 6, 12, and 24 months follow-up, respectively. The assessment after one year showed that the overall incidence of urinary dysfunction was 11.9% (5/42); 25% (4/16) male patients suffered from erectile dysfunction and 31.3% (5/16) suffered from ejaculatory dysfunction; 69.2% (19/26) female patients investigated were satisfied of their postoperative sexual life. There was no statistic difference in the two groups. Laparoscopic total mesorectal excision combined with sphincter-preserving surgery in low or ultralow rectal carcinoma is safe and practicable. It can be helpful for enhancing the probability of anus reservation, and obtains satisfactory defecation, sexual and urinary functions.

Keywords

• Rectal cancer
• laparoscope
• sphincter-preserving surgery
• quality of life