Safety and feasibility of transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in the treatment of lower rectal cancer

Abstract

To investigate the safety and feasibility of transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection for lower rectal cancer. Clinical data of seventeen patients with low rectal cancer undergoing the transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in our department from November 2014 to June 2015 were retrospectively analyzed. The main outcome measures included the operative time, intra-operative blood loss, the intra- and post-operative complication rate, the distal resection margin (DRM) length and the circumferential resection margin(CRM) status of the pathological specimen, as well as the number of lymph nodes retried. The surgery was completed smoothly for all the patients in this studying group, with no conversion to open surgery. Among all the seventeen patients, seven had a body mass index (BMI) of over 25. The average operative time was (178.0 ± 32.3) min. The average intra-operative blood loss was (50.6 ± 43.98) ml. The complications included one case of intra-operative presacral venous hemorrhage(5.9%), and 3 cases of post-operative anastomotic leak (17.6%). The average distance from the distal resection margin to the lower edge of the tumor was (2.2 ± 1.6) cm. The distal, proximal, and circumferential resection margins were all negative in 17 patients. The average number of lymph nodes retrieved was 14.5 ± 6.9. The average postoperative hospital stay was (10.6 ± 6.7) d. Patients were followed up for an average period of (7.0 ± 2.6) months. Transanal endoscopic microsurgery combined with laparoscopic total mesorectal resection in the treatment of lower rectal cancer is technically safe and feasible.