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Laparoscopic Resection of Rectal Cancer: A Comparison of Surgical and Oncologic Outcomes Between Extraperitoneal and Intraperitoneal Disease Locations

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

The extraperitoneal rectum is anatomically and biologically different from the intraperitoneal rectum, therefore, the surgical outcomes may be different. This study was designed to assess operative outcomes of laparoscopic resection of extraperitoneal (≤7 cm from the anal verge) vs. intraperitoneal rectal cancer.

Methods

Prospective data were collected from 312 patients with rectal cancer who underwent laparoscopic resection. Patients were divided into two groups: extraperitoneal (EP, n = 138) vs. intraperitoneal (IP, n = 174). Mean follow-up was 33 months.

Results

Patients with pT3/pT4 accounted for 69.6 percent of EP and 74.1 percent of IP. Circumferential margin was positive in 8.7 percent of EP and 0.6 percent of IP (P = 0.0004). Anastomotic leakage developed in 9.7 percent of EP vs. 4.6 percent of IP (P = 0.1081, overall 6.4 percent). Local recurrence rate at three years was 7.6 percent in EP and 0.7 percent in IP (P = 0.0011, overall 4 percent). By multivariate analysis, extraperitoneal location was a risk factor for local recurrence.

Conclusions

Laparoscopic resection of rectal cancer, regardless of EP or IP, provided acceptable operative outcomes. There was an increasing tendency for positive circumferential margin, leakage, and local recurrence in EP vs. IP. A multicenter, prospective study is ongoing to identify the high-risk group for local recurrence who may really benefit from neoadjuvant therapy in the era of laparoscopy.

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Acknowledgments

The authors thank Ms. Jee Sung Lee, M.S., Division of Biostatistics, Graduate School of Public Health, Korea University College of Medicine, Seoul, Korea, for statistical analysis of the data.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, #126–1, 5-ga, Anam-dong, Sungbuk-gu, Seoul, 136–705, Korea

    Seon Hahn Kim M.D.

  2. Department of Surgery, University of Ulsan College of Medicine & Asan Medical Center, Seoul, Korea

    In Ja Park M.D.

  3. Department of Surgery, Hansol Hospital, Seoul, Korea

    Yong Geul Joh M.D. & Koo Yong Hahn M.D.

Authors
  1. Seon Hahn Kim M.D.
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  2. In Ja Park M.D.
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  3. Yong Geul Joh M.D.
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  4. Koo Yong Hahn M.D.
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Corresponding author

Correspondence to Seon Hahn Kim M.D..

Additional information

Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 3 to 7, 2006.

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Kim, S.H., Park, I.J., Joh, Y.G. et al. Laparoscopic Resection of Rectal Cancer: A Comparison of Surgical and Oncologic Outcomes Between Extraperitoneal and Intraperitoneal Disease Locations. Dis Colon Rectum 51, 844–851 (2008). https://doi.org/10.1007/s10350-008-9256-x

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  • DOI: https://doi.org/10.1007/s10350-008-9256-x

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