Abstract
BackgroundIn order to overcome the shortcomings of laparoscopic intersphincteric resection (Lap ISR), an alternative method of delivering intraoperative radiotherapy by Intrabeam X-rays radiotherapy system (XRS) is proposed in this paper. Intrabeam XRS is a device that uses low-energy X-rays source generated by a mobile controller unit, which is featured in accurate irradiation, reduced complications, and less exposure. The purpose of this study is to discuss the feasibility of Lap ISR with intra-operative radiotherapy using low-energy X-rays for locally advanced ultra-low rectal cancer in Asian woman. This novel proposed method will greatly increase the anus preserving probability and improved the quality of life.MethodsA 53-year-old woman diagnosed with rectal adenocarcinoma had a strong desire to preserve the anal function and presented at the Jilin University Second Hospital, Jilin, China. The tumor’s size was 4 cm × 3 cm. It was located 2 cm from the anus merge and invaded the levator ani muscle. Preoperative clinical staging was T4N1M0 and could be reached R0 resection. After the consent form was signed by the patient, Lap ISR combined with the applicator put through the anus (natural orifice) to the tumor bed was performed and prophylactic ileostomy synchronized the anastomosis. Patient only received 1-cycle chemotherapy regimen of oxaliplatin with capecitabine postoperatively due to personal reasons. Pre- or postoperative radiotherapy was not given.ResultsAfter clinical follow-up, until now, there is not any sign of local recurrence. Anus function and short-term complications are acceptable. The short-term effect is satisfying and we look forward to further assess the long-term effect.ConclusionLaparoscopic intersphincteric resection with IORT using low-energy X-rays for the patients with late-stage ultra-low rectal cancer could provide an opportunity of preserving the anus function, and it is feasible for the selected patients.Trial registrationRetrospectively registered; Trial registration: NCT03393234; Registered time: 05 January 2017.
Highlights
In order to overcome the shortcomings of laparoscopic intersphincteric resection (Lap Laparoscopic intersphincteric resection (ISR)), an alternative method of delivering intraoperative radiotherapy by Intrabeam X-rays radiotherapy system (XRS) is proposed in this paper
Rectal cancer surgery has focused on the preservation of the sphincter anatomy and function without compromising oncological results, and laparoscopic intersphincteric resection (Lap ISR) has been increasingly being popular on saving sphincter with ultra-low rectal cancer patients whose tumor location is less than 5 cm from the anal verge or less than 3 cm from the dente line
Preoperative criteria for Lap ISR are the patients diagnosed with clinical stages T1 and T2 and N0_1 [3], and the ultra-low rectal cancer patients in T3~ 4 stage patients are suggested neoadjuvant radiation or chemo-radiation to make this approach possible with a good oncological outcome
Summary
In order to overcome the shortcomings of laparoscopic intersphincteric resection (Lap ISR), an alternative method of delivering intraoperative radiotherapy by Intrabeam X-rays radiotherapy system (XRS) is proposed in this paper. The purpose of this study is to discuss the feasibility of Lap ISR with intra-operative radiotherapy using low-energy X-rays for locally advanced ultra-low rectal cancer in Asian woman. This novel proposed method will greatly increase the anus preserving probability and improved the quality of life. Rectal cancer surgery has focused on the preservation of the sphincter anatomy and function without compromising oncological results, and Lap ISR has been increasingly being popular on saving sphincter with ultra-low rectal cancer patients whose tumor location is less than 5 cm from the anal verge or less than 3 cm from the dente line. With more minimal toxicity and exposure to surrounding structures, IORT directly delivers the designed radiation dosage to at-risk areas removed tumor
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