Abstract
BackgroundLaparoscopic tumor-specific mesorectal excision (TSME) preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer.MethodsA total of 184 patients with upper rectal cancer were retrospectively analyzed in our cancer center between April 2010 and April 2017. These patients were treated with either laparoscopic TSME (n = 46) or laparoscopic total mesorectal excision (TME) (n = 138). In the TSME group, the left colonic artery and superior rectal artery were preserved while they were not in the TME group.ResultsThe operation time in the TSME group was longer than that in the TME group (218.56 ± 35.85 min vs. 201.13 ± 42.65 min, P = 0.004). Furthermore, the number of resected lymph nodes in the TSME group was greater than that in the TME group (19.43 ± 9.46 vs. 18.03 ± 7.43, P = 0.024). The blood loss between the TSME and TME groups was not significant. No mortality occurred in either the TSME or TME groups. One patient in the TME group underwent conversion to laparotomy. The total postoperative complication rates in the TSME and TME groups were 8.7% and 17.4%, respectively. There was no difference in severe complications between the two groups (anastomotic leakage and stenosis).ConclusionsLaparoscopic TSME preserving the left colic artery and superior rectal artery can be safely conducted for upper rectal cancer.
Highlights
Total mesorectal excision (TME) is an important surgical technique to prevent the local recurrence of rectal cancer [1]
The rate of absence of the left colic artery (LCA) is 1.2%, which may be associated with a risk of anastomotic leakage due to insufficient vascularization of the proximal colonic conduit [6]
There were no significant differences in preoperative comorbidity, tumor size, depth of invasion, and lymph node metastasis between groups
Summary
Total mesorectal excision (TME) is an important surgical technique to prevent the local recurrence of rectal cancer [1]. The resection range of TME reaches 5 cm below the inferior border of the tumor and has acquired an adequate cure rate reported in previous studies for patients with rectosigmoid junction and upper rectal cancers [2]. This tumor-specific resection according to the tumor site or T staging is called tumor-specific mesorectal excision (TSME) [3]. To avoid the risk of postoperative ischemic necrosis, anastomotic leakage, colitis, and delayed stricture, it is desirable to ligate proximal to Sudeck’s point, for cases where anastomosis may be absent or insufficiently present [5]. Laparoscopic tumor-specific mesorectal excision (TSME) preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer
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