The clinical effects of trans-rectal extraction of specimen with double stapling anastomosis and trans-rectal extraction of specimen with single stapling anastomosis of 3D laparoscopic low anterior resection on rectal cancer

Abstract

Objective To assess the clinical outcomes of trans-rectal extraction of specimen with double stapling anastomosis and trans-rectal extraction of specimen with single stapling anastomosis of 3D laparoscopic low anterior resection on rectal cancer. Methods We retrospectively analyzed the clinical and pathological features of 40 patients undergoing 3D laparoscopic anus-preserving operation for rectal cancer during January 2016 to March 2018 at Shanghai East Hospital. All patients were divided into two groups according to different anastomosis methods. (1) Twenty-nine cases were undergone trans-rectal extraction of specimen with double stapling anastomosis. Briefly, the specimen of rectum was moved out through the anus. Then an Endo linear cutting stapler was used to close the rectum. The anastomosis was accomplished with double-stapling technique. (2) Eleven cases were undergone trans-rectal extraction of specimen with single stapling anastomosis. After the specimen of rectum was moved out through the anus, the rectum was closed by purse-string suture with V-Loc stitches rather than the Endo linear cutting stapler. Then, the anastomosis was completed by a circular stapler in an end to end way. The operation time, blood loss, postoperative hospitalization days, exsufflation time, complications rates were compared between two groups. Wexner incontinence scoring criteria was used to assess the function of anal sphincter after the operation. Results There was no significant difference between two groups in age, gender, BMI index, Tumor infiltration depth, operation time, blood loss, anal exhaust time, length of hospital stay, postoperative eating liquid time (P>0.05). According to WIS criteria, there were 76.9% patients whose anal sphincter function was good (WIS ≤10), and there was no patient with serious anal incontinence. Conclusions In 3D laparoscopic low anterior resection of rectal cancer, either trans-rectal extraction of specimen with double stapling anastomosis or trans-rectal extraction of specimen with single stapling anastomosis should be considered in an individualized way. Key words: Rectal neoplasms; Transrectal specimen extraction surgery; Double stapling anastomosis; Single stapling anastomosis; Natural orifice specimen extraction surgery