Abstract
BackgroundLaparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform. We report successful operations on 13 patients with clear surgical margins and no serious complications.MethodsThirteen patients [10 males and three females, age range: 48 to 69 years (median: 61 years)] with low adenocarcinoma confirmed by preoperative colonoscopic biopsy (four stage T1; nine stage T2) were resected. The distance from inferior edge of tumor to dentate line was 2 ~ 5 cm (average: 3.4 cm). Intraperitoneal laparoscopy was performed to isolate rectosigmoid and mesocolon moving toward distal end of the tumor. Perineal operation was performed in the prone clasp-knife position.ResultsThe circumferential resection margin (CRM) was negative in all cases. No serious postoperative complications occurred. There were four cases of perineal wound infection, two cases with superficial perineal wound dehiscence, and two cases with persistent postoperative sacral pain. All 13 patients passed the Wexner continence test and had satisfactory anal function during a mean 18-month postoperative follow-up period.ConclusionLaparoscopic posterior LAR of colorectal cancer is a safe and reliable treatment for patients with low colorectal cancer, increasing the chance of anal functional recovery.Trial registrationChinese Clinical Trial Register ChiCTR-ONC-14005145. Registered 19 August 2014.
Highlights
Laparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform
We reported our surgical experience with laparoscopy-assisted posterior LAR of rectal cancer cases that had a tumor edge within 2 to 5 cm from the dentate line
From June 2011 to June 2013, all 13 cases of rectal cancer were treated with laparoscopy-assisted posterior LAR in the Department of General Surgery of Beijing Chaoyang Hospital
Summary
Laparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform. Low rectal cancer is a relatively common malignant disease with high morbidity and mortality rates [1,2]. Low anterior resection has been the mainstay of surgical therapy for rectal cancer since the 1970’s. Despite the best efforts of experienced surgeons, 5-year survival rates have ranged from 27% to 42% [3]. This conventional technique has been associated with a high risk of damage to the autonomic pelvic nerve plexus, resulting in sexual and bladder dysfunction [3]. Many studies have shown that TME is a technically demanding procedure that requires excision of the intact mesorectum, in the narrow space of the pelvic cavity [3,8,9,10]
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