Abstract
Objective: to study the immediate results of laparoscopic intersphincteric resection (ISR) and ultralow anterior resection (ULAR) of the rectum. Subjects and methods. The results of surgical treatment in 42 patients operated on in the Saint Petersburg Clinical Research-Practical Center for Specialized Medical (Oncology) Cares in March 2014 to January 2015 are given. The inclusion criteria were the lower edge of cT1–3N0 adenocarcinoma 2-5 cm above the dentate line and no signs of invasion into the sphincter and levators. All the patients were divided into 2 groups: 1) 24 patients who had undergone laparoscopic ISR; 2) 18 patients who had laparoscopic ULAR. Both groups were matched for gender, age, body mass index, and CR-POSSUM predicted mortality scores. Thirty-two patients received neoadjuvant chemoradiotherapy. Results. The mean duration of operations did not differ significantly in the groups: 206 ± 46 and 216 ± 24 min (р = 0.72). The differences in the mean volume of blood loss were also insignificant: 85 and 113 ml (р = 0.93). Circular and distal resection margins were intact in all the cases. In 18 (75 %) patients in Group 1 and in 14 (77.8 %) patients in Group 2, the quality of total mesorectumectomy (TME) was rated as grade 3 according to the Quirk criteria (p = 0.83). In Group 1, complications requiring no reoperation occurred in 5 (20.8 %) cases: anastomotic incompetence in 3 (12.5 %) cases, anastomotic stricture with further bougienage in 1 (4.2 %), and urinary retention in 1 (4.2 %). In Group 2, postoperative coтplications were also observed in 5 (27.8 %) cases: necrosis of the brought-out bowel in 2 (11.1 %) patients and coloanal incompetence in 1 (5.6 %) required reoperation; 2 (11.1 %) patients underwent bougienage due to established anastomotic stricture. One month postoperatively, the Wexner constipation scoring system was used to rate the degree of encopresis: anal incontinence turned out to be significantly higher in Group 2 and amounted to 9.3 versus 6.2 in Group1. ULAR required consumables costing an average of 45 000 rubles more than did ISR. Conclusion. Both surgical procedures are comparable in the duration of a surgical intervention, the volume of intraoperative blood loss, and the quality of TME. ULAR with a reservoir is functionally more preferential.
Highlights
Ключевые слова: колоанальный анастомоз, колоректальный анастомоз, тотальная мезоректумэктомия, низкий ректальный рак, рак прямой кишки, дистальный край резекции, лапароскопическая резекция, сфинктеросохраняющие операции, стриктура анастомоза, некроз низведенной кишки, несостоятельность анастомоза
All the patients were divided into 2 groups: 1) 24 patients who had undergone laparoscopic ISR; 2) 18 patients who had laparoscopic ULAR
Both groups were matched for gender, age, body mass index, and CR-POSSUM predicted mortality scores
Summary
Ручной колоанальный или аппаратный колоректальный анастомоз? Сравнительный анализ лапароскопических низких резекций прямой кишки. Представлены результаты хирургического лечения 42 больных, прооперированных в ГБУЗ «СанктПетербургский клинический научно-практический центр специализированных видов медицинской помощи (онкологический)» с марта 2014 по январь 2015 г. Все пациенты были разделены на 2 группы: 1-ю составили 24 пациента, перенесшие лапароскопическую УНПРПК, 2-ю – 18 больных, которым была проведена лапароскопическая ИСРПК. Послеоперационные осложнения во 2-й группе также наблюдались в 5 (27,8 %) случаях: некроз низведенной кишки – у 2 (11,1 %) больных и несостоятельность колоанального анастомоза – у 1 (5,6 %) потребовали повторной операции; 2 (11,1 %) пациентам выполнили бужирование в связи с установленной стриктурой анастомоза. Ключевые слова: колоанальный анастомоз, колоректальный анастомоз, тотальная мезоректумэктомия, низкий ректальный рак, рак прямой кишки, дистальный край резекции, лапароскопическая резекция, сфинктеросохраняющие операции, стриктура анастомоза, некроз низведенной кишки, несостоятельность анастомоза
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
