Clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis

Abstract

Objective To investigate the clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis. Methods The clinical data of 52 patients with low rectal cancer who underwent laparoscopic radical resection using transanal telescopic anastomosis at the General Hospital of Beijing Military Command from March 2010 to December 2014 were retrospectively analyzed. Patients with T2N1 stage received the routine chemotherapy after operation. The evaluating indexes of clinical efficacy included operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time, duration of hospital stay, postoperative complications, marginal states, postoperative anal defecation function and local recurrence of tumors. Patients were followed up by outpatient and inpatient examinations and telephone interview up to March 2015, and follow-up included the occurrence of complications, postoperative anal defecation function and local recurrence of tumors. Measurement data with normal distribution were presented as ±s, and measurement data with skew distribution were described as M (range). Results Fifth-two patients underwent transanal laparoscopic sphincter-preserving radical resection using telescopic anastomosis successfully. The operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time and duration of hospital stay were (150±36)minutes, (16±9)mL, 12±9, (2.0±1.5)days, (5.0±2.0)days and (9.0±2.5)days, respectively. One patient with anastomotic fistula was cured by transverse colostomy, with a stoma healing 3 months later. The postoperative pathological examination showed there were 46 patients with high- and moderate- differentiated adenocarcinomas and 6 patients with poor-differentiated adenocarcinomas, and T1-2N0M0 stage was detected in 29 patients and T2N1-2M0 stage in 23 patients. The distal and circumferential resection margins of tumors were negative. The defecation of 6-9 times/day in 52 patients after postoperative early food intake was reduced to 3-6 times/day after taking orally compound diphenoxylate tablets 2 pills each time and 3 times a day for 2-3 days. Twenty-three patients with T2N1 stage or above underwent postoperative routine chemotherapy. Fifth-two patients were followed up for a median time of 29.7 months (range, 3.0-51.0 months). The defecation control was improved remarkably at 2-3 months after operation. There was 94.2%(49/52) of patients with Kirwan grade 1of anal defecation function at postoperative month 12, and anal defecation function had basically returned to normal. There were 3 patients with Kirwan grade 2 of anal defecation function. One patient complicated with anastomotic stenosis had remission by anal expansion treatment during follow-up. Patients had no local recurrence of tumor with good quality of life. Conclusion Laparoscopic radical resection for low rectal cancer using transanal telescopic anastomosis is safe and feasible without abdominal incision, with a good cosmetic effect and satisfactory short-term outcome. Key words: Rectal neoplasms; Radical resection; Telescopic anastomosis; Laparoscopy