Laparoscopic Proctectomy in Locally Advance Rectal Cancer: Prolapse Delayed Anastomosis Compared to Immediate Anastomosis

Locally advance rectal cancer was treated in 144 patients of stages II and III with positive nodes only between 2014 and 17. Combined laparoscopic and trans-anal-rectal excision were performed in all patients, 54 (37.5%) had delayed, and 90 (62.5%) had immediate coloanal anastomoses. Both groups received diverting stoma. Seven patients (4.9%) had pre-sacral collection and anastomotic leakage of which 5 (9.3%) had delayed and 2 (2.2%) had immediate anastomosis. Postoperative obstructions occurred in 5 (9.3%) patients of group delayed and 2 (2.2%) of immediate group. Sepsis and peritonitis was observed in delayed group only—2 (3.7%). One subject died in postoperative due to bleeding and pelvic sepsis in immediate group. Positive circumferential margins above and below were not different between the two groups (p = 0.371, 0.631).Overall survival was 86.8% CI 95% = 74.3–93.5 in the delayed group and 75% CI 95% = 64.6–82.8 in the immediate group. Similarly, 5-year survival was 76% CI 95% = 61.6–85.6 and 69.7% CI 95% = 58.5–78.4 for delayed and immediate anastomoses groups respectively. Overall survival was not significantly different between the two groups (related tests p = 0.429). We conclude from a non-randomized comparative study that combined laparoscopic and trans-anal excision of locally advanced rectal cancer when treated with delayed anastomosis has somewhat higher surgical complications than immediate anastomosis group. However, no difference was observed in the long- and short-term survival between these 2 groups.