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Abdominoperineal resection: laparoscopic versus conventional.

A prospective comparison of laparoscopic (Group 1 = 18 patients) and conventional (Group 2 = 18 patients) abdominoperineal resection in patients with low rectal cancer was carried out. Parameters studied included the length of the procedure, ileus, and hospitalization; the rate of conversion; and the morbidity and mortality rates. The mean (SD) operating time was slightly longer for laparoscopic than for standard surgery: 229 (SD = 56) versus 208 (SD = 45) min; p = 0.47. Moreover, the mean (SD) time to reintroduction of diet of 2.5 (SD = 1.1) days versus 3.8 (SD = 2.1, p < 0.005) and the length of hospital stay of 7.4 (SD = 4.1) days versus 12.9 (SD = 3.9, p < 0.005) were statistically lower in Group 1. Histopathological examination of the resection specimens (length of specimen, lateral margins, and number of lymph nodes retrieved) showed similar results in the two groups. Major complications were few and occurred in a similar proportion in the two groups (4 x 3). The conversion rate was 10% (2/20). One death (5.5%) and two reoperations (11.1%) occurred in group 2. Local recurrence was also similar (1 x 3). There were no port sites or abdominal incisions recurrences. This clinical study indicates that oncologic laparoscopic abdominoperineal resection is not only technically feasible and safe but also provides better postoperative recovery and the same rate of early recurrence and survival as the open technique.