International Session（Symposium）4(JSGS・JSGE・JGES)
Fri. November 6th   14:30 - 17:00   Room 2: Kobe International Exhibition Hall No.2 Building Hall (South)
IS-S4-2_S
 Benefits of trans-perineal minimally invasive abdominoperineal resection for rectal cancer: outcomes and techniques
Takeru Matsuda1, Kimihiro Hasegawa1, Yoshihiro Kakeji1
1Department of Surgery, Kobe University
Background: Although trans-perineal minimally invasive approach for abdominoperineal resection (tp-APR) based on the concept of transanal total mesorectal excision has recently been incorporated for rectal cancer, its safety and usefulness remains unclear.
Methods: This retrospective study included consecutive 53 patients with rectal cancer who received APR between May 2009 and December 2019. The clinical outcomes were compared between the patients who received tp-APR (the tp-APR group, n=26) and standard laparoscopic APR (the lap-APR group, n=27). The operative techniques of tp-APR are also presented in video.
Results: Operative time and intraoperative blood loss were significantly less in the tp-APR group (479 min vs. 559 min, P = 0.033 and 15 g vs. 200 g, P = 0.018, respectively). Postoperative complications ≥ Clavien-Dindo grade II was significantly less in the tp-APR group (46.2 % vs. 85.2 %, P < 0.001). Severe perineal wound complications (Clavien-Dindo grade III) were much less in the tp-APR group (15.4 % vs. 40.7 %). Postoperative hospital stay was significantly shorter in the tp-APR group (22 days vs. 36 days, P < 0.001). The rate of positive radial margin did not differ between the groups. No local recurrence at the perineal site has developed so far in either group.
Conclusion: Trans-perineal minimally invasive approach for APR seems superior to standard lap-APR in terms of short-term outcomes, especially in reduction of perineal wound problems.
Index Term 1: ta-TME
Index Term 2: tp-APR
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