Two-stage treatment (Mukai's method) with hybrid 2-port HALS (Mukai's operation) for complete bowel obstruction by left colon cancer or rectal cancer

Abstract

Abstract. During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome. IntroductionIn recent years, minimally invasive laparoscopy-assisted colorectal surgery (LACS) has become common, and its indications have expanded considerably from additional resection for early stage I colorectal cancer to radical curative resection of advanced stage II/III cancer and palliative surgery for stage IV patients (1-5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid-HALS combined with surgery under direct vision are popular (6-9), pure LACS performed via 5-6 ports together with a small incision of 35-45 mm has become the mainstream procedure in Japan (10,11). However, the use of pure LACS is limited in patients with complete bowel obstruction due to left colon cancer, which is an oncologic emergency, and those who need partial resection of tumors infiltrating other organs such as the bladder. In addition, it has been pointed out that the operating time is relatively long (5,(12)(13)(14). In order to solve these problems, we devised hybrid 2-port HALS (Mukai's operation), which involves HALS using a small incision of 45-55 mm as the hand access site, combined with manipulation under direct vision (15). The features of this surgical procedure include the following: i) full grasping manipulation, as well as palpation, can be done with the left hand, enabling protective and smooth handling of even large and heavy tumors; ii) there is little difficulty for anesthesiologists and operating room staff since the procedure is an extension of conventional laparotomy and takes less time than pure LACS and; iii) it is less demanding for surgeons and less time is required to master the procedure, a supervised surgeon who only has experience of standard laparotomy is able to perform it without difficulty. Due to such advantages, hybrid 2-port HALS is applicable to all colorect...

Comparison of hand-assisted laparoscopic surgery (HALS) and conventional laparotomy in patients with colorectal cancer: Final results from a single center

“…Consequently, at present, single-center reviews of HALS are performed in countries other than Japan (9,24). Previously, 212 patients with primary colorectal cancer (stages I-III) underwent radical curative resection by hand-assisted laparoscopic surgery (HALS) (n=98) or conventional laparotomy (CL) (n=114) and were compared with respect to 3-year relapse-free survival (3Y-RFS) and 3-year overall survival (3Y-OS) (25) (4,(24)(25)(26)(27).…”

Stage II/III cancer of the rectosigmoid junction: An independent tumor type?

“…In women, if infiltration into the posterior vaginal wall or the uterus is confirmed, combined resection of these organs may be required. In patients with Rb cancer, the most important issue is whether resection of the rectum with total mesorectal excision can be performed with an adequate margin of 2-3 cm at the distal border of the tumor, and successfully achieving this is particularly difficult in male patients with a high BMI with narrow pelvises (14)(15)(16). Invasion of adjacent organs, such as the prostate and the vagina is another problem for patients with Rb cancer located on the anterior wall of the lower rectum.…”

Anal function-preserving subtotal intersphincteric resection/partial external sphincteric resection with hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for very low stage I rectal cancer: A case report

“…Dissection of the puborectal, rectococcygeal and pelvic floor muscles was performed by laparoscopy-assisted manipulation (9,10). Following dissection of the area proximal to the dentate line, the tumor resection scar was identified under direct vision via the transanal route.…”

“…Since then, we have operated on 180 patients, including 100 cases of colon cancer and 80 cases of rectal cancer (9,10 located at the lower edge of the rectum/below the peritoneal reflection (Rb) region, the patient is left with a permanent stoma that creates a significant mental and physical burden, although the 5-year survival rate is over 90% (4,5). Therefore, in recent years the technique of intersphincteric resection (ISR) via the transanal approach has been promoted for the preservation of anal function in patients with lower rectal cancer (11)(12)(13)(14).…”

“…Since then, we have operated on 180 patients, including 100 cases of colon cancer and 80 cases of rectal cancer (9,10 …”