Long-term outcomes and failure patterns after laparoscopic intersphincteric resection in ultralow rectal cancers

Wen-Long Qiu; Xiao-Lin Wang; Jun-Guang Liu; Gang Hu; Shi-Wen Mei; Jian-Qiang Tang

doi:10.4240/wjgs.v15.i6.1104

Long-term outcomes and failure patterns after laparoscopic intersphincteric resection in ultralow rectal cancers

World J Gastrointest Surg. 2023 Jun 27;15(6):1104-1115. doi: 10.4240/wjgs.v15.i6.1104.

Authors

Wen-Long Qiu¹, Xiao-Lin Wang², Jun-Guang Liu³, Gang Hu¹, Shi-Wen Mei¹, Jian-Qiang Tang⁴

Affiliations

¹ Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
² Department of General Surgery, The Second Hospital of Yulin, Yulin 100021, Shaanxi Province, China.
³ Department of General Surgery, Peking University First Hospital, Beijing 100021, China.
⁴ Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. doc_tjq@hotmail.com.

Abstract

Background: Intersphincteric resection (ISR), the ultimate anus-preserving technique for ultralow rectal cancers, is an alternative to abdominoperineal resection (APR). The failure patterns and risk factors for local recurrence and distant metastasis remain controversial and require further investigation.

Aim: To investigate the long-term outcomes and failure patterns after laparoscopic ISR in ultralow rectal cancers.

Methods: Patients who underwent laparoscopic ISR (LsISR) at Peking University First Hospital between January 2012 and December 2020 were retrospectively reviewed. Correlation analysis was performed using the Chi-square or Pearson's correlation test. Prognostic factors for overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were analyzed using Cox regression.

Results: We enrolled 368 patients with a median follow-up of 42 mo. Local recurrence and distant metastasis occurred in 13 (3.5%) and 42 (11.4%) cases, respectively. The 3-year OS, LRFS, and DMFS rates were 91.3%, 97.1%, and 90.1%, respectively. Multivariate analyses revealed that LRFS was associated with positive lymph node status [hazard ratio (HR) = 5.411, 95% confidence interval (CI) = 1.413-20.722, P = 0.014] and poor differentiation (HR = 3.739, 95%CI: 1.171-11.937, P = 0.026), whereas the independent prognostic factors for DMFS were positive lymph node status (HR = 2.445, 95%CI: 1.272-4.698, P = 0.007) and (y)pT3 stage (HR = 2.741, 95%CI: 1.225-6.137, P = 0.014).

Conclusion: This study confirmed the oncological safety of LsISR for ultralow rectal cancer. Poor differentiation, (y)pT3 stage, and lymph node metastasis are independent risk factors for treatment failure after LsISR, and thus patients with these factors should be carefully managed with optimal neoadjuvant therapy, and for patients with a high risk of local recurrence (N + or poor differentiation), extended radical resection (such as APR instead of ISR) may be more effective.

Keywords: Intersphincteric resection; Laparoscopic surgery; Rectal cancer; Recurrence; Risk factors.