Xinxiang Li, Yuwei Wang, LiyongHuang, Sanjun Cai

Department of Colorectal Surgery, Fudan UniversityShanghai Cancer Center

Objective:The aim of the study is to evaluate thesafety and feasibility of laparoscopic abdominal peritoneal resection (LAPR)for rectal cancer compared with conventional open abdominal peritonealresection (OAPR) by a case-controlled analysis. Method: A total of 106rectal cancer patients underwent OAPR were matched with 106 patients whounderwent LAPR in a 1 to 1 fashion based on pathological staging of the diseaseand neoadjuvant chemoradiation during the same time period between 2011and 2013from Fudan University Shanghai Cancer Center. Data regarding perioperativeclinical outcomes and postoperative pathology were collected and comparedbetween the two groups. Result: No significant difference was foundbetween LAPR cases and OAPR cases in terms of age, gender, BMI, ASA grade anddistance from the tumor to anal verge. The operation time (180.8±47.8min vs172.1±49.2 min, P=0.190), operative blood loss (93.9±60.0 ml vs 88.4±55.2ml, P=0.494), total number of retrieved lymph nodes (12.9±6.9 vs12.9±5.4, P=0.974), rate of positive circumferential margin (0.0% vs0.9%, P=1.000), surgical complication rate (12.3% vs 15.1%, P=0.549)and all pathological characteristics were comparable between the LAPR and OAPRcases, respectively. Compared with the OAPR cases, the LAPR cases showedsignificantly shorter postoperative analgesia (2.4±0.7 days vs 2.7±0.6 days, P<0.001),earlier first flatus pass (57.3±7.9 hours vs 63.5±9.2 hours, P<0.001)shorter time of urinary drainage (6.5±3.4 vs 7.8±1.3, P<0.001), andshorter postoperative admission (11.2±4.7 days vs 12.6±4.0 days, P-0.014).Similar results were found in patients administrated with preoperativeneoadjuvant chemoradiation in subgroup analysis. Conclusion: LAPR forrectal cancer patients is safe, feasible and associated with earlier recoveryand shorter admission time treated with or without neoadjuvant chemoradiation.Further prospective study with longer follow-up and larger case number iswarranted to provide evidence to compare the long-term prognosis andoncological outcomes.

Key Words: Laparoscopic  abdominal peritoneal resection  rectal