Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2024; 30(30): 3574-3583
Published online Aug 14, 2024. doi: 10.3748/wjg.v30.i30.3574
Clinical application of eight-zone laparoscopic dissection strategy for rectal cancer: Experience and discussion
Chang Chen, Xiang Zhang, Xin Li, Yan-Lei Wang
Chang Chen, Department of General Surgery, Rongchang People's Hospital, Chongqing 250012, China
Xiang Zhang, Yan-Lei Wang, Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Xin Li, Department of General Surgery, Huantai Branch of Qilu Hospital of Shandong University, Zibo 255000, Shandong Province, China
Co-first authors: Chang Chen and Xiang Zhang.
Author contributions: Chen C and Zhang X contributed equally; Zhang X and Wang YL designed the study; Wang YL, Zhang X, Li X and Chen C performed the surgery; Chen C and Li X performed subject follow up and control subject data collection; Chen C and Zhang X performed the statistical analysis; Chen C and Zhang X wrote the manuscript; Chen C, Zhang X, Li X and Wang YL revised the manuscript for final submission.
Institutional review board statement: This study was approved by the Ethics Committee of Scientific Research of Shandong University Qilu Hospital, No. KYLL-2020-125.
Informed consent statement: Consent forms have been acquired from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Lei Wang, MD, PhD, Adjunct Associate Professor, Deputy Director, Doctor, Department of Colorectal Surgery, Qilu Hospital, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan 250012, Shandong Province, China. yanleiwang@hotmail.com
Received: May 31, 2024
Revised: July 5, 2024
Accepted: July 24, 2024
Published online: August 14, 2024
Processing time: 70 Days and 0.2 Hours
Abstract
BACKGROUND

The incidence of rectal cancer is increasing worldwide, and surgery remains the primary treatment modality. With the advent of total mesorectal excision (TME) technique, the probability of tumor recurrence post-surgery has significantly decreased. Surgeons' focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual functions. Among these concerns, the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neurovascular bundle have become critical. To explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions, we propose the eight-zone dissection strategy for pelvic floor anatomy.

AIM

To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection strategy.

METHODS

We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1, 2021 and December 1, 2023. This study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer, among whom 109 patients underwent traditional pelvic floor dissection strategy, and 109 patients received the eight-zone dissection strategy.

RESULTS

There were no significant differences in general characteristics between the two groups. Patients in the eight-zone dissection group had higher postoperative specimen integrity (88.1% vs 78.0%, P = 0.047). At the 3-month follow-up, patients in the eight-zone surgery group had better scores in urinary issues (6.8 ± 3.3 vs 5.3 ± 2.5, P = 0.045) and male sexual desire (2.2 ± 0.6 vs 2.5 ± 0.5, P = 0.047) compared to the traditional surgery strategy group.

CONCLUSION

This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and effective. Compared with the traditional pelvic floor dissection strategy, this approach can reduce the risk of nerve injury and minimize the impact on urinary and sexual functions. Therefore, we recommend the clinical application of this strategy to better serve patients with rectal cancer.

Keywords: Eight-zone dissection strategy, Rectal cancer, Lateral ligament dissection, Nerve injury, Total mesorectal excision surgery

Core Tip: Our study addresses the imperative to minimize the adverse impact of surgery on urinary and reproductive functions, thereby enhancing the overall quality of life for patients. Specifically, we introduce the innovative eight-zone dissection strategy for pelvic floor anatomy within total mesorectal excision procedures, aimed at reducing postoperative complications in these domains. By comparing outcomes between traditional pelvic floor dissection strategies and our novel approach, we demonstrate a significant reduction in postoperative complications related to urinary and reproductive functions. These findings underscore the potential of the eight-zone dissection strategy to mitigate the negative effects of surgery in these critical areas.