Clinical and Translational Research
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2021; 13(1): 12-23
Published online Jan 15, 2021. doi: 10.4251/wjgo.v13.i1.12
Laparoscopy-assisted transanal total mesorectal excision for lower rectal cancer: A feasible and innovative technique
Ying-Jie Li, Lin Wang, Ting-Ting Sun, Ai-Wen Wu
Ying-Jie Li, Lin Wang, Ting-Ting Sun, Ai-Wen Wu, Gastrointestinal Cancer Center Unit III, Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing 100142, China
Ying-Jie Li, Ai-Wen Wu, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing 100142, China
Author contributions: Wu AW contributed to conception and design of the study, drafting and final approval of the manuscript; Li YJ and Sun TT collected the data and drafted the manuscript; Wu AW, Wang L, and Li YJ provided quality control of the study especially the surgery part, and acquired the data; Li YJ contributed to the study design and statistical analysis; All authors approved the final manuscript.
Supported by the National Natural Sciences Foundation of China, No. 81773214
Institutional review board statement: This study and the protocol were reviewed and approved by the Ethics Committee at Beijing Cancer Hospital (approval no. 2017-p2-181-01).
Clinical trial registration statement: This registration policy applies to prospective, randomized, controlled trials only.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Wen Wu, MD, PhD, Professor, Teacher, Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Beijing Institute for Cancer Research, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. drwuaw@sina.com
Received: August 17, 2020
Peer-review started: August 17, 2020
First decision: September 16, 2020
Revised: September 28, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: January 15, 2021
Processing time: 143 Days and 6.9 Hours
Abstract
BACKGROUND

Transanal total mesorectal excision (taTME) is a new technique with many potential technical advantages. Laparoscopy-assisted taTME is a combination of transabdominal taTME and transluminal endoscopic surgery taTME. Laparoscopy-assisted taTME is a combination of techniques such as minimally invasive surgery, intersphincter-assisted resection, natural orifice extraction, ta minimally invasive surgery, and ultralow-level preservation of the anus.

AIM

To verify the feasibility and safety of an innovative technique of taTME for treatment of cancer located in the lower rectum.

METHODS

From January 2016 to March 2018, we attempted to perform laparoscopy-assisted taTME surgery in 24 patients with lower rectal cancer.

RESULTS

The new technique of laparoscopy-assisted taTME was successfully performed in all 24 patients. Mean operating time was 310.0 min and mean intraoperative blood loss was 69.1 mL. The mean time to passing of first flatus was 3.1 d, and mean postoperative hospital stay was 9.2 d. Two patients were given postoperative analgesics due to anal pain. Twenty-three patients were able to walk in first 2 d, and five patients had postoperative complications.

CONCLUSION

Laparoscopy-assisted taTME is suitable for selected patients with lower rectal cancer, and this technique is worthy of further recommendation.

Keywords: Laparoscopy-assisted; Total mesorectal excision; Technique; Lower rectal cancer; Trans-abdominal; Trans-anus

Core Tip: We report our initial experience with transanal total mesorectal excision for distal rectal cancer, with a 100% success rate of intraoperative preservation of the anal sphincter. The patients in this study had a narrow pelvis, mild obesity, and distal rectal lesions, making the operation extremely difficult. Most of the patients had undergone neoadjuvant chemoradiation. We believe that this procedure is feasible for selected patients with lower rectal cancer, and is worthy of further recommendation.