Intersphincteric resection for very low rectal cancer: clinical outcomes of open versus laparoscopic approach and multidimensional analysis of the learning curve for laparoscopic surgery

Abstract Background Laparoscopic rectal cancer surgery is regarded as more complex because of its technical difficulties in pelvic exposure, dissection, and sphincter preservation. This study therefore aimed to investigate the feasibility of laparoscopic resection for low rectal cancer using intersphincteric resection (ISR) and to assess its short-term oncological outcomes. Further, we intended to analyze the learning curve for laparoscopic surgery and identify the factors influencing the learning curve. Methods Patients with low rectal cancer who received open or laparoscopic ISR were retrospectively chart reviewed. The surgical and oncological outcomes were evaluated. Comparisons of operating time, estimated blood loss, surgical outcomes, and histopathologic status were analyzed. Also, operating time was used as a technical indicator for learning curve analysis. Results The mean estimated blood loss was 265 mL (range, 100–800 mL) in the open group and 104 mL (range, 30–250 mL) in the laparoscopic group. There was a significant difference between these two groups ( P P  = 0.034 and P  = 0.004, respectively). Multifactorial analysis showed that operating time was associated with surgeons’ experience ( Conclusions Our data show that laparoscopic ISR for low rectal cancer is feasible and safe. Surgeons’ experience improved operating time and postoperative complications.