Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: A case report

R.M.I.M. Senevirathne,H.M.K.B. Herath,W.U.C. Alwis,K.B. Galketiya

doi:10.4038/slaj.v2i2.7

R.M.I.M. Senevirathne, H.M.K.B. Herath + Show 2 more

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https://doi.org/10.4038/slaj.v2i2.7

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Abstract

Introduction: Surgical resection of lower rectal tumours is often considered to be technically challenging especially when the anal sphincter mechanism needed to be spared to avoid lifelong colostomy. Stapling has made anastomosis below peritoneal reflection easier. However with very low tumours stapling too may be difficult due to short rectal stump. An alternative is to perform a transanal pull through and a colo-anal anastomosis. Use of laparoscopic resection in these cases reduces the morbidity associated with open resections. We report a case of successful use of tansanal pull-through technique to avoid diverting stoma in resection of a lower rectal tumour.

Highlights

Surgical resection of lower rectal tumours is often considered to be technically challenging especially when the anal sphincter mechanism needed to be spared to avoid lifelong colostomy
Upon histopathological examination of the specimen, the distal resection margin was clear of tumour by 5 mm
Surgical resection is an essential component in the treatment of rectal cancers and the two main surgical procedures that are being used today are the anterior resection (AR) and abdominoperineal resection with permanent colostomy

Summary

Introduction

Surgical resection of lower rectal tumours is often considered to be technically challenging especially when the anal sphincter mechanism needed to be spared to avoid lifelong colostomy. We report a case of successful use of tansanal pull-through technique to avoid diverting stoma in resection of a lower rectal tumour. Biopsy and histopathological examination of the lesion revealed a moderately differentiated adenocarcinoma She underwent a CT scan of the chest, abdomen and pelvis which showed a lower rectal tumour extending to a length of about 8 cm proximally with no evidence of invasion into mesorectal fascia (Figure 1). There were enlarged mesorectal lympnodes and metastatic deposits in segment IV and VIII of the liver and in both lung fields (Stage T3N2M1) Her pretreatment carcinoembryonic antigen (CEA) level was 2.72 ng\ml (Normal

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Conclusion