Laparoscopic ultralow anterior resection versus laparoscopic pull-through with coloanal anastomosis for rectal cancers: a comparative study.

BACKGROUND

Ultralow anterior resection for mid and distal rectal cancers has been reported routinely performed using either a laparoscopic ultralow anterior resection (LAR) or laparoscopic pull-through with coloanal anastomosis (LPT). This study evaluated the postoperative and functional outcomes.

METHODS

Between January 2007 and December 2008, 40 consecutive patients had laparoscopic surgery for rectal cancers. The data were prospectively collected.

RESULTS

There were 21 patients (21 men; mean age 61.2 ± 3.2 years standard error of the mean [SEM]) in the LAR group and 19 (16 men; mean age 61.4 ± 2.4 years SEM) in the LPT group. Tumor characteristics, adjuvant therapy given, mean follow-up (overall 33.5 ± 1.4 months SEM), intraoperative time, blood loss, mesorectum quality, conversion rate (LAR n = 2, LPT n = 1), pain score, time for ileostomy to function, subsequent incontinence scores, and complication rates (LAR n = 7, LPT n = 9) were not different between groups, but benign anastomotic strictures were higher after LPT (n = 4, LAR n = 0, P = .042). The latter was associated with chemoradiotherapy (P = .015). There were 2 systemic cancer recurrences both in the LPT group but no local recurrences to date.

CONCLUSIONS

The LAR technique may have less risk of anastomotic strictures, particularly with adjuvant therapy. LPT may be considered selectively for a bulky distal rectal tumor in a small pelvis with comparable functional results.