Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 28, 2015; 21(16): 4969-4974
Published online Apr 28, 2015. doi: 10.3748/wjg.v21.i16.4969
Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions
Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan
Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China
Author contributions: Li SY, Chen Gang, Yu B and Ji XQ designed the surgical strategy; Li SY, Chen Gang, Cui W, Yuan Q and Du JF performed the operation; Wei XJ, Cui W, Dong X, Zuo FY and Chen G analyzed data; Li SY and Du JF wrote the paper.
Supported by National Natural Science Foundation of China, No. 81041025 and No. 81000189.
Ethics approval: This is a retrospective clinical study, therefore, no approval from the Ethics Committee is required due to the nature of the study design. Authors apply an exemption of clinical trial registration.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors confirm that this article content has no conflict of interest.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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: +86-10-66721188 Fax: +86-10-66721188
Received: October 25, 2014
Peer-review started: October 28, 2014
First decision: December 11, 2014
Revised: January 9, 2015
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: April 28, 2015
Processing time: 183 Days and 23.4 Hours
Abstract

AIM: To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.

METHODS: From March 2010 to June 2014, 30 patients (14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection. The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases. In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0. Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut. Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor. For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum. The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum.

RESULTS: For the present cohort of 30 cases, the mean operative time was 178 min, with an average of 13 positive lymph nodes detected. One case of postoperative anastomotic leak was observed, requiring temporary colostomy, which was closed and recovered 3 mo later. The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases. Twelve months after surgery, 94.4% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. The patients were followed up for 1-36 mo, with an average of 23 mo. There was no local recurrence, and 17 patients survived for > 3 years (with a survival rate of 100%).

CONCLUSION: Laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.

Keywords: Laparoscopic resection; Rectal neoplasms; Anus-preserving rectectomy; Telescopic anastomosis

Core tip: This study assesses the laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions. Thirty cases of lower rectal cancer have been treated using this procedure with satisfactory outcomes in follow-up observation. We concluded that laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.