Complete laparoscopic total mesorectal excision with an intersphincteric resection and coloplasty pouch anal anastomosis for lower rectal cancer

Abstract

Abstract:This pilot study aimed to develop a new technique, complete laparoscopic total mesorectal excision (TME) with an intersphincteric resection (ISR) and coloplasty pouch anal anastomosis to avoid any further abdominal incision other than laparoscopic port sites, and to assess the impact on short-quality of life and oncological outcomes of this technique. After laparoscopic TME, large bowel was dissected at the level of the promontory. Then, laparoscopic construction of the coloplasty pouch was performed. Simultaneously, a rectal specimen with ISR was excised using the transanal approach. Coloplasty pouch was gently pulled from pelvic thorough anal and a hand-sewn coloplasty pouch anal anastomosis was created. We had performed 8 surgeries using the new technique. Though one patient developed pelvic infections, but intestinal continuity could be maintained and no local and distant recurrence was recognized in other patients. We foresee this novel approach to have significant clinical potential for lower rectal cancer patients with ISR.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

“…Comparison of the stool frequency, the use of antidiarrheal medication, and continence have confirmed no significant differences between treatment with coloplasty pouch and colonic J-pouch. Patients' perceptions measured by the Fecal Incontinence Quality of Life Scale and WIS Score are also equivalent between the two techniques [ 9 ]. A crucial prerequisite is a meticulous preoperative evaluation of local tumour spread with rectal magnetic resonance imaging excluding infiltration of the external sphincter [ 10 ].…”

Comparation of Laparoscopic Intersphincteric Resection and Abdominoperineal Resection for Ultra-Low Rectal Cancer Patients - a Retrospective Analysis, and a Meta-analysis of Oncology Outcome

“…It enables preservation of the sphincter in patients who would have undergone abdominoperineal resection in the past. However, with ISR, there is a potential risk of increased recurrence [6], because preservation of the anal canal, external sphincter, and levator ani muscles for such low tumors may compromise distal margins [7]. Thus, the oncologic outcomes may vary greatly depending on the skills of the surgeons.…”