Laparoscopic Surgery For Rectal Cancer Research Articles

Internal hernia of the stomach associated with colostomy after laparoscopic surgery for rectal cancer: a case report

BackgroundColostomy via the intraperitoneal route is often performed during laparoscopic Hartmann’s operation or abdominoperineal resection. Internal hernia of the small intestine often occurs after colostomy. This report shows a rare case of internal hernia of the stomach associated with sigmoid colostomy after laparoscopic abdominoperineal resection for rectal cancer.Case presentationThe patient was a 79-year-old woman with a sigmoid colostomy. Computed tomography scan showed a markedly distended stomach in the space between the lifted sigmoid colon and the lateral abdominal wall. Laparoscopy revealed that the body of the stomach had passed through a hernia orifice located between the lifted sigmoid colon and the left lateral abdominal wall. The dislocated stomach was restored to its normal position, and the lateral defect was closed with the lateral peritoneum and the lifted sigmoid colon laparoscopically.ConclusionsInternal hernia associated with colostomy can lead to not only obstruction of the small intestine, but also obstruction of the stomach. We reported a successful case of the suture repair for the internal hernia of the stomach associated with colostomy.

Real-world impact of laparoscopic surgery for rectal cancer: a population-based analysis.

Randomized trials have demonstrated equivalent oncologic outcomes and decreased morbidity in patients with rectal cancer who undergo laparoscopic surgery (lapsx) compared with open surgery (opensx). The objective of the present study was to compare short-term outcomes after lapsx and opensx in a real-world setting. A national discharge abstract database was used to identify all patients who underwent rectal cancer resection in Canada (excluding Quebec) from April 2004 through March 2015. Short-term outcomes examined included same-admission mortality and length of stay (los). Of 28,455 patients, 82.4% underwent opensx, and 17.6%, lapsx. The use of lapsx increased to 34% in 2014 from 5.9% in 2004 (p < 0.0001). Same-admission mortality was lower among patients undergoing lapsx than among those undergoing opensx (1.08% and 1.95% respectively, p < 0.0001). On multivariable analysis, the odds of same-admission mortality with lapsx was 36% lower than that with opensx (odds ratio: 0.64; p = 0.003). Median los was shorter after lapsx than after opensx (5 days and 8 days respectively, p = 0.0001). The strong association of lapsx with shorter los was maintained on multivariable analysis controlling for patient, surgeon, and hospital factors. For patients with rectal cancer, shorter los and decreased same-admission mortality are associated with the use of lapsx compared with opensx.

Results of laparoscopic resection in high-risk rectal cancer patients.

Obesity, neoadjuvant-radiotherapy, tumour proximity to the anal verge and previous abdominal surgery are factors that might increase the intra-operative difficulty of laparoscopic rectal cancer surgery. However, whether patients with these 'high-risk' characteristics are subject to worse short- or long-term outcomes is debated. The aim of this study is to examine the short- and long-term clinical and oncological outcomes of patients receiving laparoscopic rectal surgery with any of these high-risk characteristics and compare them with patients that do not possess any of these high-risk features. For the purpose of this study data from consecutive patients receiving laparoscopic rectal cancer resections between 2006 and 2016 from two centres were analysed. High-risk patients were defined as patients with either one of the following characteristics: BMI ≥ 30, neoadjuvant chemoradiotherapy, tumour < 8cm from the anal verge and previous abdominal surgery. A total of 313 patients were identified (227 high risk, 86 low risk). Short-term outcomes were similar between the two groups with the exception of blood loss and length of stay, which were higher in the high-risk group (10 vs 2.5ml, p = 0.045; 7 vs 5days, p = 0.001). There were no statistically significant differences in 5-year overall survival (79.7% vs 79.8%, p = 0.757), disease-free survival (76.8% vs 69.3%, p = 0.175), distant disease-free interval (84.8% vs 79.7%, p = 0.231) and local recurrence-free interval (100%, 97.4%, p = 0.162) between the two groups. Similar short- and long-term outcomes can be achieved in high-risk and low-risk patients receiving laparoscopic rectal surgery. The presented data support the suitability of laparoscopic surgery for this group of patients.

Laparoscopic and Robotic Surgery for Rectal Cancer—Comparative Study Between Two Centres

We compared short-term and long-term surgical and oncological outcomes of robotic surgery versus hand-assisted laparoscopic surgery for rectal cancers patients. Study was conducted at the National Cancer Institute and Yonsei Cancer Centre from August 2006 to December 2012. We prospectively reviewed all patients who underwent RS and HALS for upper and middle third rectal cancers. Patients’ demographics, postoperative short-term and long-term outcomes were assessed. Baseline patients’ characteristics were similar in both groups. Average operative time was 321.3 ± 70 min for robotic surgery versus 106.0 ± 37 min for hand-assisted laparoscopic surgery, P < 0.001). Higher number of patients (n = 74, 94.9%) with tumour in the upper rectum was found in hand-assisted laparoscopic group (P < 0.01). Perioperative complications were more common in the robotic surgery group (9 vs. 5 patients). In all stages, 3-year overall survival was 86.9% in the hand-assisted laparoscopic group vs. 89.6% in the robotic group: 80.0% vs. 79.2 for stage I and 82.4% vs. 88.9 for stage II and III. The 3-year DFS was 83.6% in hand-assisted laparoscopic group vs. 83.2%—robotic surgery group considering all stages. Anastomotic leakage, bleeding, number of postoperative complications, overall survival and disease-free survival were similar and not much different between robotic and hand-assisted laparoscopic rectal cancer surgery.

Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence.

The aim of this study was to evaluate oncological outcome for patients with and without anastomotic leakage after colon or rectal cancer surgery. The role of anastomotic leakage in oncological outcome after colorectal cancer surgery is still topic of debate and impact on follow-up and consideration for further treatment remains unclear. Patients included in the international, multicenter, non-inferior, open label, randomized, controlled trials COLOR and COLOR II, comparing laparoscopic surgery for curable colon (COLOR) and rectal (COLOR II) cancer with open surgery, were analyzed. Patients operated by abdominoperineal excision were excluded. Both univariate and multivariate analyses were performed to investigate the impact of leakage on overall survival, disease-free survival, local and distant recurrences, adjusted for possible confounders. Primary endpoints in the COLOR and COLOR II trial were disease-free survival and local recurrence at 3-year follow-up, respectively, and secondary endpoints included anastomotic leakage rate. For colon cancer, anastomotic leakage was not associated with increased percentage of local recurrence or decreased disease-free-survival. For rectal cancer, an increase of local recurrences (13.3% vs 4.6%; hazard ratio 2.96; 95% confidence interval 1.38-6.34; P = 0.005) and a decrease of disease-free survival (53.6% vs 70.9%; hazard ratio 1.67; 95% confidence interval 1.16-2.41; P = 0.006) at 5-year follow-up were found in patients with anastomotic leakage. Short-term morbidity, mortality, and long-term oncological outcomes are negatively influenced by the occurrence of anastomotic leakage after rectal cancer surgery. For colon cancer, no significant effect was observed; however, due to low power, no conclusions on the influence of anastomotic leakage on outcomes after colon surgery could be reached. Clinical awareness of increased risk of local recurrence after anastomotic leakage throughout the follow-up is mandatory.Trial Registration: Registered with ClinicalTrials.gov, number NCT00387842 and NCT00297791.

Vertical supraumbilical incision versus left lower oblique incision for specimen retrieval during laparoscopic rectal surgery

Objective: To compared the short-term surgical outcomes of the vertical supraumbilical incision with the left lower oblique incision for specimen retrieval in laparoscopic resection for rectal cancer. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) rectal cancer confirmed by colonoscopy and pathological examination; (2) undergoing the operation for the first time; (3) laparoscopic rectal surgery performed by the same surgeon team; (4) age of > 18 years and < 76 years old. According to above criteria, clinical data of 178 consecutive patients scheduled for laparoscopic surgery for rectal cancer at Department of Gastrointestinal Surgery of Renji Hospital between March 2015 and December 2017 were collected. Based on incision site of the mini-laparotomy, patients were classified to the vertical supraumbilical incision group (n=75) and the left lower oblique incision group (n=103). There were no significant differences in baseline data, such as age, gender, body mass index (BMI), tumor diameter, preoperative carcinoembryonic antigen (CEA) level, score of American Society of Anesthesiologists, TNM stage, between the two groups (all P>0.05). Perioperative variables and follow-up data were compared between two groups. Results: Between the vertical supraumbilical incision group and the left lower oblique incision group, the operation time [(131.7±3.7) minutes vs. (138.5±3.5) minutes], operative bleeding volume [(138.9±11.5) ml vs. (154.3±10.3) ml], length of auxiliary incision [(4.0±0.1) cm vs. (4.0±0.1) cm], and distance from anastomosis to dentate line [(3.8±0.1) cm vs. (4.2±0.1) cm] were not significantly different (all P>0.05). As compared to the left lower oblique incision group, patients in vertical supraumbilical incision group had earlier flatus [(62.7±2.3) hours vs. (69.2±1.7) hours, t=2.282, P=0.023], earlier ambulation [(41.9±1.8) hours vs. (46.78±1.42) hours, t=2.131, P=0.032], lower pain VAS scores at postoperative 24 hours (2.0±0.1 vs. 2.4±0.1, t=2.172, P=0.032) and 48 hours (2.7±0.1 vs. 3.0±0.1, P<0.05), and lower incidence of postoperative incisional hernia [6.7% (5/75) vs. 9.7% (10/103), χ(2)=3.942, P=0.042]. However, the postoperative fluids intake time, hospitalization days, pain VAS scores at postoperative 12 hours and postoperative complications (wound infection, anastomotic leakage, urinary retention, intestinal obstruction) were not significantly different between the two groups (all P>0.05). Conclusion: The vertical supraumbilical incision in laparoscopic resection for rectal cancer can reduce the degree of postoperative pain, facilitate early recovery of intestinal function and decrease the incidence of incisional hernia.

Short-term efficacy of hand-sewn anastomosis of gastrointestinal tract in total laparoscopic radical surgery for low rectal cancer

目的： 探讨完全腹腔镜低位直肠癌行手工吻合的安全性与可行性。 方法： 采用回顾性病例系列研究方法，对2017年5—12月期间，大连医科大学附属第二医院胃肠外科28例完全腹腔镜低位直肠癌行手工吻合患者的临床资料进行回顾性分析。本组患者均接受经自然腔道取标本手术（NOSES）后，将乙状结肠与直肠行"端端吻合"，手工全层连续缝合，先缝合直肠左侧壁，沿直肠后壁连续缝合5~6针；然后同样方法从沿直肠前壁连续缝合5~6针。记录并发症发生情况，并分析术中和术后恢复情况。随访时间截至2018年12月。 结果： 28例患者均顺利完成手术，无中转开腹病例，无围手术期死亡病例。手术时间为（182.5±57.5）min，消化道重建手工吻合时间为15（9~25）min。术后共5例（17.9%）发生并发症，2例吻合口漏患者经引流、营养支持治疗后逐渐自然愈合；1例腹腔感染患者经抗感染、引流后恢复；1例肺部感染患者经抗感染治疗后痊愈；1例切口出现脂肪液化患者，经换药引流后痊愈。无腹腔出血、乳糜漏、输尿管损伤、肠梗阻等并发症发生，无围手术期死亡病例。术后随访12~19个月，中位随访15（12~19）个月，未见肿瘤复发者，有3例患者诉存在肛门异物感；行小肠造口还纳手术后，8例患者诉排粪次数多，控粪能力差，余患者无明显不适主诉。 结论： 完全腹腔镜低位直肠癌行手工吻合安全可行，近期疗效好。.

Effects of preceding endoscopic treatment on laparoscopic surgery for early rectal cancer.

Endoscopic treatment for rectal cancer, such as endoscopic mucosal resection and endoscopic submucosal dissection, causes inflammation, oedema and fibrosis in the surrounding tissue. However, little is known about the effect of these endoscopic therapies on salvage laparoscopic rectal surgery. The objective of this retrospective cohort study was to analyse the effect of preceding endoscopic treatment on the outcomes of laparoscopic surgery for rectal cancer. We analysed 53 patients who underwent laparoscopic surgery for rectal cancer with clinical Tis or T1 at our department between May 2011 and June 2019. Data from 30 patients who underwent laparoscopic surgery after preceding endoscopic treatment (Group E+S) were compared with those of 23 patients who underwent laparoscopic surgery alone (Group S). There was no significant difference between the groups with respect to preoperative details. The mean operative time tended to be longer in Group E+S, and the volume of intra-operative blood loss was greater in Group E+S than in Group S (median 63ml vs 10ml, P=0.049). There were no significant differences between the groups in other surgical parameters or oncological outcomes. Laparoscopic surgery after endoscopic treatment for rectal cancer may be difficult due to an increased risk of intra-operative bleeding. Long-term prognosis after surgery was not affected by preceding endoscopic treatment in rectal cancer.

Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study

The differences between the costs of robotic rectal resection and of the laparoscopic approach are still not well known. The aim of this study was to evaluate the cost-effectiveness of robotic versus laparoscopic surgery. We conducted an observational, comparative, prospective, non-randomized study on patients having laparoscopic and robotic rectal resection between February 2014 andMarch 2018 at the Sanchinarro University Hospital, Madrid. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). The primary endpoint was to compare cost effectiveness in the robotic and laparoscopic surgery groups. A willingness-to-pay of 20,000€ and 30,000€ per QALY was used as a threshold to determine the most cost-effective treatment. A total of 81 RRR and 104 LRR were included. The mean operative costs were higher for RRR (4307.09€ versus 3834.58€; p = 0.04), although mean overall costs were similar (7272.03€ for RRR and 6968.63€ for the LLR; p = 0.44). Mean QALYs at 1year for the RRR group (0.8482) was higher than that associated with LRR (0.6532) (p = 0.018). At a willingness-to-pay threshold of 20,000€ and 30,000€ there was a 95.54% and 97.18% probability, respectively, that RRR was more cost-effective than LRR. Our data regarding the cost-effectiveness of RRR versus LRR shows a benefit for RRR.

Laparoscopic Surgery for Rectal Cancer Improves Overall Survival

Background: Laparoscopic surgery for colon cancer has been widely adopted as current evidence shows similar oncological results with open surgery. Evidence suggesting similar outcomes for laparoscopic rectal cancer surgery is lacking. We assessed the outcomes of patients undergoing laparoscopicand openTotal Mesorectal Excision(TME)for rectal cancer in our unit.

Survival in laparoscopic surgery for colon and rectal cancer

Introduction: Laparoscopic surgery of the colon has been performed since the early nineties of the past century. Despite its advantages of less postoperative pain, faster recovery of intestinal and respiratory function among others, its acceptance has not been the same as with other laparoscopic procedures. In oncologic surgery particularly, the main cause of non-acceptance has been the fear of not respecting the oncologic criteria and the reports on port site metastases in the abdominal wall. Objective: To determine patient survival after laparoscopic colorectal resections. Material and methods: A descriptive, retrospective and longitudinal study was carried out at the Centro Nacional de Cirugía de Mínimo Acceso (CNCMA-NCMIS) between January 2005 and December 2015. The variables studied were age, gender, reason for surgery, surgical technique, mortality, overall survival. Results: When comparing the survival curves according to the location of the tumor, it was found that those who had undergone surgery for a rectal tumor had a significantly lower survival during complete follow-up than patients with tumors in the rest of the sites (p=0,032). Significant differences were also found in the survival curves regarding the stage of the disease; stage IV patients showed the worst survival during the follow-up of this series. Conclusions: Survival in our study, with the limitations given by a retrospective analysis, in patients who had surgery for colorectal cancer with minimally invasive techniques at five and ten years was 70,9% and 66,8% respectively, an appropriate rate and similar to that described in scientific medical literature.

Survival in Laparoscopic Surgery for Colon and Rectal Cancer

Survival in Laparoscopic Surgery for Colon and Rectal Cancer

Robotic rectal cancer surgery: Results from a European multicentre case series of 240 resections and comparative analysis between cases performed with the da Vinci Si and Xi systems

IntroductionRobotic systems are designed to address the limitations of laparoscopic surgery, leading to a growing interest in robotic rectal surgery. However, certain technical limitations associated with the previous systems (da Vinci S & Si) have arguably slowed down its wholesale adoption. The latest robotic platform, the da Vinci Xi, addresses these limitations. This study aims to examine the short-term surgical outcomes of 240 single-docking fully-robotic rectal cancer resections and compare the outcomes of cases performed with the da Vinci Xi vs Si systems. Materials and methodsAll consecutive patients receiving robotic rectal cancer resections from three centres between 2013 and 2018 were identified from prospectively collated databases. The baseline characteristics and short-term surgical outcomes are presented and the da Vinci Xi vs Si system outcomes are analysed. ResultsA total of 240 patients were identified (124 Si, 116 Xi). Median operation-time and length-of-stay were 260 minutes and 6 days respectively. Conversion and 30-day mortality rates were 0. The da Vinci Si vs Xi system analysis shows that operation-time was lower in the Si group (230 vs 300 min, p = 0.000) but length-of-stay, lymph node yield and circumferential resection margin favoured the Xi group (7 vs 5 days, p = 0.010; 17 vs 21, p = 0.000; 92.7% vs 99.1%, p = 0.020). ConclusionSingle-docking fully-robotic rectal cancer surgery is safe, feasible and can lead to good short-term outcomes, making it a good alternative to laparoscopic rectal cancer surgery. The new systems technological advances may result in better short-term outcomes but further larger scale observational studies are required if we are to reach such a conclusion.

Clinical and oncological outcomes of single-incision vs. conventional laparoscopic surgery for rectal cancer.

To evaluate the clinical and oncological outcomes of single-incision laparoscopic surgery (SILS) vs. conventional laparoscopic surgery (CLS) for patients with rectal cancer (RC) who underwent total mesorectal excision (TME) surgery. This was a retrospective case-control study of patients with RC operated between 12/2013 and 12/2017 in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine. In total, 177 patients who underwent CLS and 51 who underwent SILS met the inclusion and exclusion criteria and were matched 1:1 using propensity score matching method (PSM). Compared with the CLS group, the SILS group showed shorter operation time [105 (40) vs. 125 (55) min, P = 0.045], shorter total incision length [4 (1) vs. 6.5 (1.5) cm, P < 0.001], lower VAS score on POD2 [1 (1) vs. 2 (1), P < 0.001], shorter time to soft diet [7 (1) vs. 8 (2) days, P = 0.048], and shorter length of hospital stay [9 (2) vs. 11 (3) days, P < 0.001]. The postoperative complications were similar between two groups [1(2%) vs. 5 (9.8%), P = 0.205]. No readmissions or mortality in either group occurred within 30days of surgery. All 102 specimens met the requirements of TME. No significant differences were observed in the pathologic outcomes between the two groups. The median follow-up period was 32.6months in the SILS group and 36.8months in the CLS group (P = 0.053). The 3-year disease-free survival rates and overall survival rates of the SILS and CLS groups were 89.8% vs. 96.0% (P = 0.224) and 90.9% vs. 96.9% (P = 0.146), respectively. Compared with CLS, TME surgery for rectal cancer can be performed safely and effectively using the SILS technique with better cosmetic results, less postoperative pain, faster postoperative recovery, and acceptable clinical and oncological outcomes.

Regional Variation in the Utilization of Laparoscopy for the Treatment of Rectal Cancer: The Importance of Fellowship Training Sites.

Compared to open rectal surgery, laparoscopy is associated with lower perioperative morbidity but unclear oncologic outcomes. Unique technical challenges exist with laparoscopic rectal surgery and access based on geographical location is unknown. The purpose of this study was to determine whether proximity to colorectal fellowship training sites influences laparoscopy utilization for rectal cancer surgery. Population based retrospective spatial analysis assessing regional rates of laparoscopy use in patients (≥ 18years of age) undergoing rectal cancer surgery in Canada (excluding Quebec) from April 2008 to March 2014. Overall, 11,261 patients underwent rectal cancer surgery. Four Canadian colorectal fellowship training centers were identified. Rectal surgeries were performed laparoscopically 27% of the time, and this significantly increased from 18.1 to 40.3% between 2008 and 2014. Multivariate analysis adjusting for province, disease, hospital, patient, and surgeon factors demonstrated that patients living within 25km of a colorectal fellowship training site had 2.5 times higher odds of laparoscopy use and those living within 26-100km had 1.8 times higher odds of laparoscopy [95% confidence interval (CI) 2.14-2.71, p < 0.001, 95% CI 1.64-2.07, p < 0.001 respectively]. High-volume surgeons and hospitals were associated with increased laparoscopy use (1.25, 95% CI 1.11-1.4 and 1.36, 95% CI 1.21-1.53, p < 0.001 respectively). Significant geographical variation to laparoscopic rectal cancer surgery access in a publicly funded healthcare system currently exists. The inverse relationship between colorectal fellowship training site distance and undergoing a laparoscopic rectal surgery highlights the current disparities in Canadian health care and the need for surgical mentorship to increase uptake of advanced surgical techniques in rural neighbourhoods.

Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery.

Some recent studies have suggested that fluorescence angiography with indocyanine green (ICG) might be useful for preventing anastomotic leakage (AL) after laparoscopic colorectal surgery. However, its efficacy has not been proven. We evaluated whether intraoperative ICG fluorescence angiography could decrease the AL rate with laparoscopic colorectal cancer surgery. This retrospective study included patients with colorectal cancer who underwent laparoscopic surgery at our institution between March 2014 and December 2018. Patients were divided into two groups: with or without ICG fluorescence angiography. The primary outcome was the rate of AL. A total of 488 patients were included: 223 patients in the ICG group and 265 patients in the no-ICG group. In the ICG group, the transection line was changed to a more proximal location in seven patients (3.1%), including one patient with transverse colon surgery and six with rectal surgery. None of these seven patients developed AL. There were 18 ALs (3.7%) overall. The AL rate was 1.8% in the ICG group and 5.3% in the no-ICG group. For colon cancer, there were no significant differences in the AL rate between the groups (p = 0.278). In rectal cancer, the AL rate was significantly lower in the ICG group than in the no-ICG group (3.5% vs. 10.5%, p =0.041). After propensity score matching, the AL rate was also significantly lower in the ICG group for rectal cancer (p =0.044). ICG fluorescence angiography can potentially reduce the AL rate with laparoscopic rectal cancer surgery.

Standard (8\u2009weeks) vs long (12\u2009weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR)

BackgroundThe optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing.MethodsThe trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks.DiscussionTo date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23–30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer.Trial registrationClinicalTrials.gov NCT3465982.

Pure transanal total mesorectal excision for rectal cancer: experience with 55 cases.

BackgroundAlthough the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision (h-taTME), a completely incisionless surgical procedure has not yet been developed. This study was performed to explore the efficacy of pure taTME (p-taTME) without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer.MethodsWe retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018. Relevant patient characteristics and clinical information including the surgical procedure, specimens, pathological characteristics, and patients’ post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed.ResultsFifty-five patients who had undergone p-taTME were included in this study. They comprised 32 (58.2%) men and 23 (41.8%) women with a mean age of 65.6 ± 10.6 years and mean body mass index of 23.4 ± 3.3 kg/m2. The median surgical time was 180.0 (range, 130–360) min and estimated blood loss was 25.0 (range, 15–80) mL. The commonest post-operative complication was varying degrees of faecal incontinence (56.4%). However, such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients’ quality of life.Conclusionsp-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer, especially in those with obesity or a narrow pelvis. However, further studies of the indications and long-term efficacy are needed to verify the suitability of this procedure.

Laparoscopic Surgery of Rectal Cancer and Ileostomy

Laparoscopic Surgery of Rectal Cancer and Ileostomy

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery.

PurposeLimited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.MethodsFrom March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.ResultsThe midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).ConclusionIn terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.