Brief Article
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World J Gastroenterol. Jun 28, 2013; 19(24): 3841-3846
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3841
Anus-preserving rectectomy via telescopic colorectal mucosal anastomosis for low rectal cancer: Experience from a Chinese cohort
Shi-Yong Li, Gang Chen, Xue Bai, Fu-Yi Zuo, Guang Chen, Jun-Feng Du, Xiao-Jun Wei, Wei Cui
Shi-Yong Li, Gang Chen, Xue Bai, Fu-Yi Zuo, Guang Chen, Jun-Feng Du, Xiao-Jun Wei, Wei Cui, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China
Author contributions: Li SY, Chen G, Bai X and Zuo FY designed the surgical strategy; Li SY, Chen G, Cui W and Du JF performed the operation; Wei XJ and Chen G analyzed data; and Li SY and Du JF wrote the paper.
Supported by Grants from the National Natural Science Foundation of China, No. 81041025 and 81000189
Correspondence to: Shi-Yong Li, MD, Director, Department of General Surgery, General Hospital of PLA Beijing Military Command, 5 Nanmencang, Dongsi Shitiao, Beijing 100700, China. lisybz@163.com
Telephone: +86-10-84008099 Fax: +86-10-84008099
Received: May 14, 2013
Revised: May 24, 2013
Accepted: June 1, 2013
Published online: June 28, 2013
Processing time: 45 Days and 12.1 Hours
Abstract

AIM: To investigate the safety and efficacy of anus-preserving rectectomy via telescopic colorectal mucosal anastomosis (TCMA) for low rectal cancer.

METHODS: From August 1993 to October 2012, 420 patients including 253 males and 167 females with low rectal cancer underwent transabdominal and transanal anterior resection, followed by TCMA. The distance between the anus and inferior margin of the tumor ranged from 5 to 7 cm, and was 5 cm in 6 patients, 6 cm in 127, and 7 cm in 287 patients. Tumor-node-metastasis staging showed that 136 patients had stage I, 252 had stage II and 32 had stage III. Fifty-six patients with T3 or over received preoperative neoadjuvant chemoradiotherapy.

RESULTS: The postoperative follow-up rate was 91.9% (386/420) with a median time of 6.4 years. All 420 patients underwent radical resection. No postoperative death occurred. Postoperative complications included anastomotic leakage in 13 (3.1%) patients and anastomotic stenosis in 7 (1.6%). The local recurrence rate after surgery was 6.2%, the hepatic metastasis rate was 13.2% and the pulmonary metastasis rate was 2.3%. The 5-year survival rate was 74.0% and the disease-free survival rate was 71.0%. Kirwan classification showed that continence was good in 94.4% of patients with stage I when scored 12 mo after resection.

CONCLUSION: TCMA for patients with low rectal cancer leads to better quality of life and satisfactory defecation function, and lowers anastomotic leakage occurrence, and might be one of the safe operative procedures in anus-preserving rectectomy.

Keywords: Low rectal cancer; Rectectomy; Telescopic colorectal mucosal anastomosis; Reconstruction; Abdominoperineal resection

Core tip: Li et al developed the telescopic colorectal mucosal anastomosis technique based on the experiences and lessons from several sphincter-preserving operations under preconditions of low rectal resection, which improved the anastomotic stoma and alleviated tension. With this modified technique used over the past 20 years, the incidence of anastomotic leakage was significantly decreased and the long-term outcome was satisfactory with good anal function and a lower rate of incontinence.