Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2528-2537
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2528
Lone-Star retractor perineal exposure method for laparoscopic abdominal perineal resection of rectal cancer
Jun Ma, Dai-Bin Tang, Yu-Quan Tang, Da-Tian Wang, Peng Jiang, Ya-Ming Zhang
Jun Ma, Dai-Bin Tang, Da-Tian Wang, Peng Jiang, Ya-Ming Zhang, Department of General Surgery, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Yu-Quan Tang, Department of Anesthesiology, Anqing Municipal Hospital, Anqing 246000, Anhui Province, China
Author contributions: Ma J reviewed the final manuscript; Ma J wrote and edited the original draft; Tang DB and Tang YQ contributed to data collection and analysis; Wang DT and Jiang P reviewed the literature; and all authors have read and approved the final manuscript.
Supported by the Research Projects Foundation at Universities of Anhui Province, No. 2023AH050577; and Research Projects Foundation at the Science and Technology Bureau of Anqing City, No. 2023Z1001.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Anqing Municipal Hospital.
Informed consent statement: All patients or their representatives provided informed consent for inclusion in the study.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.
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: Ya-Ming Zhang, BMed, Doctor, Surgeon, Surgical Oncologist, Department of General Surgery, Anqing Municipal Hospital, No. 352 Renmin Road, Anqing 246000, Anhui Province, China. zhangyaming2014@163.com
Received: March 18, 2024
Revised: May 12, 2024
Accepted: July 11, 2024
Published online: August 27, 2024
Processing time: 151 Days and 11.7 Hours
Abstract
BACKGROUND

The abdominal perineal resection (APR), historically referred to as Mile’s procedure, stands as a time-honored surgical intervention for rectal cancer management. Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer, including those with ultralow rectal cancer. Despite these improvements, APR maintains its irreplaceable role in the clinical landscape, particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles. Optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient’s subsequent long-term prognosis.

AIM

To evaluate the value of Lone-Star retractor (LSR) perineal exposure method in the treatment for laparoscopic APR of rectal cancer.

METHODS

We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023, including 20 patients who underwent the APR procedure with a LSR perineal exposure method (LSR group) and 18 patients who underwent the APR procedure with a conventional perineal exposure method (control group). In the LSR group, following incision of the skin and subcutaneous tissue, the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.

RESULTS

A total of 38 patients underwent laparoscopic APR, none of whom were found to have distant metastasis upon intraoperative exploration. Perineal blood loss, the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group. A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group (P < 0.05). The incidence of infection via the perineal incision in the LSR group was significantly lower than that in the control group (P < 0.05). No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.

CONCLUSION

The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and allow one surgeon to perform the perineal operation.

Keywords: Rectal cancer; Lone-Star retractor; Abdominal perineal resection; Perineal exposure method; Technique

Core Tip: Abdominal perineal resection (APR) is an important method for the treatment of low rectal cancer. However, optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with surgical safety and long-term prognosis. Herein, we introduced the application of the Lone-Star retractor (LSR) method in APR. According to our study, the application of the LSR technique might be helpful for perineal exposure during APR for rectal cancer, which could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and achieve a one-person perineal operation.