Rectal Resection Research Articles

And after surgery, what's new for the rectal cancer survivor?

Low anterior resection syndrome is a common but underestimated complication after rectal cancer surgery that significantly impacts the quality of life of the surviving patient. It is characterized by symptoms such as fecal incontinence and voiding dysfunction and affects up to 90% of patients undergoing low anterior rectal resection. The etiology of the syndrome is multifactorial with no clear determining factor. It includes the use of preoperative radiotherapy, the indication for a protective ileostomy, sphincteric lesions, nerve damage to the rectal autonomic plexuses, and changes in left colon motor function. Although various therapeutic modalities have been shown to be effective in the management of the symptoms of the syndrome, there is still no standard treatment or patient selection pattern. In this article, a critical review of the therapeutic possibilities for patients who have survived rectal surgery will be made.

Preservation of inferior mesenteric artery reduces short- and long-term defecatory dysfunction after laparoscopic colorectal resection for diverticular disease: An RCT.

The quality of life after surgery for diverticular disease is mainly linked to the presence and severity of postoperative defecatory disorders. These symptoms are frequently related to the sigmoid and rectal denervation following the arterial ligation. The preservation of Inferior Mesenteric Artery performing colorectal resections seems to reduce denervation, which led to a better defecatory function. This study aimed to assessing the efficacy of inferior mesenteric artery preservation following colonic resections for diverticular disease in terms of reduced defecatory disorders and improved quality of life. This is a prospective randomized controlled trial entirely conducted at St. Maria Goretti and St. Andrea Hospitals. Between January 2012 and January 2018 each patient scheduled for sigmoidectomy, left colonic or rectal resection for diverticular disease were included in the study and randomly divided in two groups. Colorectal resections were performed either preserving the inferior mesenteric artery or not. The incurrence of defecatory disorders and their impact on QoL of defecatory disorders were assessed with 6 questionnaires, administered at 6 and12months and after 6years from surgery and with an anorectal manometry performed after 6months and 5years. 219 patients were evaluated during the study showing a statistically lower incidence and severity of defecatory disorders in the group of patients whose inferior mesenteric artery was preserved. These defecatory disorders remained stable over the time. The study showed a statistically better quality of life in patients who experienced less defecatory disorders. Inferior Mesenteric Artery preserving in colonic resection for diverticular disease allows to improve defecatory function by reducing the denervated colonic tract. This led to better quality of life and less impairment of daily activities also after 6years from surgery. The study was registered in ClinicalTrials.gov with number NCT06506552.

Age Matters: Early-Onset Rectal Cancer Exhibits Higher Rates of Pathological Complete Response: A Retrospective Analysis of the Influence of Young Age on Treatment Success in Stage II-III Rectal Cancer.

The incidence of rectal cancer has decreased overall, but the incidence of early-onset rectal cancer (eoRC) has increased. Early-onset rectal cancer and late-onset rectal cancer (loRC) differ due to phenotypical, genetic characteristics, and higher stage presentations in eoRC. Thus, eoRC patients undergo more aggressive neoadjuvant treatments. This paper was designed to evaluate the impact of age on the pathological complete response rates in sporadic locally advanced rectal cancer. All patients with stage II-III rectal cancer who underwent neoadjuvant therapy and curative rectal resection between January 2018 and December 2023 were included and allocated to eoRC (<50 years) and loRC (≥50 years) groups based on their age at diagnosis. A total of 381 patients were included (93 eoRC and 288 loRC). Preoperative radiological imaging revealed higher clinical nodal staging in the eoRC group (p = 0.002). A higher proportion of eoRC resulted in a pathological complete response compared with loRC (29% vs. 18.8%, p = 0.035). The rate of pathological complete response in eoRC and loRC did not differ between patients treated by total neoadjuvant therapy (TNT) and those treated by standard chemoradiotherapy (29.2% vs. 28.6%, p = 0.95 in eoRC and 21.7% vs. 25.9%, p = 0.097 in loRC). Multivariable analysis resulted in young age of onset (odds ratio 2.68; 95% confidence interval 1.11-6.51; p = 0.029) and KRAS wildtype (odds ratio 3.37; 95% confidence interval 1.25-9.07; p = 0.016) as being independent predictors of pathological complete response. Sporadic eoRC and KRAS wildtype tumors are predictive factors for pathological complete response in stage II-III rectal cancer.

Study of surgical feasibility and outcome of laparoscopic surgery in malignant rectal tumors

ABSTRACT Objective To assess the viability, limitations, technical challenges, and outcomes of malignant rectal tumors laparoscopic mesorectal resection with the assessment of postoperative continence. Patients and Methods The study involved 20 people who had malignant rectal tumors. All patients underwent laparoscopic mesorectal resection. Data were recorded and investigated during Preoperative, operative, and postoperative periods. Results Low anterior, anterior, and intersphincteric resections were performed in 30%, 7%, and 35% of patients, respectively. The mean operative period lasted was on average of 3.10 ± 0.72 h. Only one case (5%) showed postoperative complications. The peristalsis became audible after one to two days, on an average of 1.65 ± 0.49 days. The hospital staying mean duration was 4.25 ± 0.72. Only for 7 patients with intersphincteric resection, the mean Wexner score was 3.0 ± 1.91 after the closure of ileostomy. Patients who underwent low anterior resection had significantly longer postoperative hospital stays (p = 0.020). There was a substantial relationship between the number of both the resected lymph nodes (LN) and the involved ones (p < 0.001). Conclusion Laparoscopic mesorectal excision for rectal tumors is superior nowadays on traditional open approach, has no increased operative time and has privileges of decreasing postoperative pain, decreasing complications, decreasing the hospital stay, early recovery and fast first bowel motion and helps for better visualization and resection of all related lymph nodes. Intersphincteric mesorectal excision of rectal tumors is preferred for all patients below 60 years old with distal rectal tumors regardless of the tumor lower edge’s extended length from the anal verge as long as the external sphincters are preserved.

Key steps in exposure techniques for robotic total mesorectal excision (TME)

Abstract Aim The use of robotic surgery is increasing significantly. Specific training is fundamental to achieve high quality and better oncological outcomes. This work defines key exposure techniques in robotic total mesorectal excision (TME). Based on a modular approach, macro- and microtractions for exposure in every step of a robotic TME are identified and described. The aim is to develop a step-by-step technical guide of the exposure techniques for a robotic TME. Methods Twenty-five videos of robotic rectal resections performed at Champalimaud Foundation (Lisbon, Portugal) with the Da Vinci™ Xi robotic platform were examined. Robotic TME was divided into modules and steps. Modules are essential phases of the procedure. Steps are exposure moments of each module. Tractions are classified as macro- and microtractions. Macrotraction is the grasping of a structure to expose an area of dissection. Microtraction consists in the dynamic grip of tissue to optimize macrotraction in a defined area of dissection. Results The procedure videos reviewed showed homogeneity concerning surgical methodology. Eight modules are outlined: abdominal cavity inspection and exposure, approach to and ligation of the inferior mesenteric vessels, medial to lateral dissection of the mesocolon, lateral colon mobilization, splenic flexure takedown, proctectomy with TME, rectal transection, and anastomosis. Each module was divided into steps, with a total of 45 steps for the entire procedure. This manuscript characterizes macrotraction and microtraction fine-tuning, detailing the large-scale macrotractions and the precision of microtractions at each step. Conclusion Tissue exposure techniques in robotic TME are key to precise dissection. This modular guide provides a functional system to reproduce this procedure safely; the addition of the exposure techniques could serve as a training method for robotic rectal cancer surgery.

Outcomes of Minimally Invasive Rectal Cancer Resection: Insights From a Resource-Limited Setting.

Minimally invasive approaches for rectal cancer treatment are emerging as the standard of care. Robotic surgery is unfeasible across the country due to constrained resource allocation. This study aimed to assess the oncologic efficacy of laparoscopic resection for rectal cancer in a resource-limited setting. A propensity score-matched analysis was carried out to compare the oncological outcomes of laparoscopic and open rectal cancer resection at a high-volume tertiary cancer centre in South India. Two hundred and twenty patients were included (110 patients in each group). The median follow-up was 93 months. There was no difference in positive circumferential resection margin between laparoscopic and open group (4.5% vs. 6.4%, p = 0.55), with a significantly better nodal yield in laparoscopic group. There was no significant difference between the laparoscopic and open groups in terms of local recurrence (5.1% vs. 8.3%, p = 0.12), 5-year disease-free survival (86% vs. 81%, p = 0.22, HR 0.699, 95% CI 0.353-1.27) or overall survival (85% vs. 76%, p = 0.21, HR 0.658, 95% CI 0.340-1.27). The mean cost between the two groups had no difference. In a resource-limited setting with good expertise, laparoscopic surgery is an effective minimally invasive option that has good survival outcomes without imposing a financial burden on patients.

Prediction of anorectal dysfunction in the combined treatment of rectal cancer

AIM: to assess the risk of severe low anterior resection syndrome (LARS) in patients with rectal cancer after combined treatment.PATIENTS AND METHODS: from July 2022 to November 2023, 50 patients with rectal cancer underwent radiation with a total focal dose of 50–54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The ileostomy was closed after 4 months. Prior to and after radiation, the anorectal function was assessed using high-resolution anorectal manometry (HRAM) and the LARS scale.RESULTS: the most significant predicting factors for severe LARS were maximal contraction pressure and first sensation volume. Three months after ileostomy closure, the patients were divided into groups depending on the HRAM parameters. Group 1: nine patients with severe LARS (34 points on the LARS scale), with a decrease in maximal contraction pressure by ≥ 30% and an increased first sensation volume by ≥ 60%, according to HRAM. Group 2: four patients out of 36 had severe LARS (31 points on the LARS scale), with a decrease in maximal contraction pressure by 5–29% and an increased first sensation volume by 10–59%, according to HRAM. Group 3: in 5 patients with a decreased maximal contraction pressure by ≤ 4% and an increased volume of the first sensation by ≤ 9%, LARS did not develop.CONCLUSION: a decrease in the maximal contraction pressure by 30% or more and an increase in the volume of the first sensation by 60% or more after radiation therapy can increase the risk of severe LARS. This group of patients requires prevention and correction of anorectal dysfunction.

Initial experience and results of robotic lateral pelvic lymph node dissection in locally advanced rectal cancer—a single center experience of 17 consecutive procedures

PurposeWe have evaluated lateral pelvic lymph node dissection (LPLND) in combination with rectal resection in the treatment of locally advanced rectal cancer in a specialized colorectal surgical department with a focus on safety and feasibility.MethodsThe study analyzed surgical-pathologic outcomes in 17 consecutive patients who underwent robotic LPLND and rectal resection between May 2018 and June 2024 at a high-volume colorectal cancer center in Denmark. Patients were selected for the procedure based on lateral lymph node (LLN) diameter ≥ 8 mm before and ≥ 5 mm after neoadjuvant treatment.ResultsOut of 17 patients (15 men and 2 females) included in this study, 13 patients (76%) had undergone neoadjuvant therapy. The median age was 63 years (range 35–79) with a median BMI of 25.6 kg/m2 (range 19.4–34.5). The total median operation time was 335 min (range 182–526 min) with no conversions necessary. Additional resection of structures beyond the total mesorectal excision plane was performed in eight patients (47%). The median hospital stay was 4 days (range 2–14) and one patient was readmitted within 30 days. Seven patients experienced postoperative complications within 30 days, with only one CD complication ≥ grade 3. The median number of resected LLNs was 4 (range 0–11) per patient and malignant LLNs were verified in three patients (17.6%).ConclusionThis study shows that simultaneous robot-assisted LPLND and rectal resection can be performed safely and effectively in selected patients with locally advanced rectal cancer, with a short hospital stay and few readmissions and postoperative complications.

Stapled Transanal Resection of Rectum (STARR) Procedure for Obstructed Defecation Syndrome Caused by Rectocele and Rectal Intussusception: An Initial Experience

Background: Obstructed defecation syndrome (ODS) is a troublesome condition for the patient which affect the quality of life. It is difficult to determine the single effective modality of treatment of ODS. Though ODS is more common in the women than men, rate of diagnosis of ODS in female is lower due to shyness of patient to visit to doctor. Objective: Study was conducted to see the effectiveness of stapled transanal resection of rectum (STARR) procedure for obstructed defecation syndrome caused by internal rectal prolapse and anorectocele. Methods: This prospective study was done including 37 patients (female 35 and male 02). These patients had undergone STARR procedure from January 2015 to September 2023 in Rangpur medical college and two private hospitals. Only those patients had undergone STARR procedure who suffered from ODS due to internal rectal prolapse or rectocele and failed to response to adequate first line medical therapeutics. Patients were diagnosed by careful evaluation of history, Longo's ODS score, DRE, proctoscopy, colonoscopy, cinedefecography and MR defecography. Patients were followed up at 1, 3 and6 months after surgery. During follow up patientssatisfaction was evaluated by comparing preoperative and postoperative score. Results: Average time needed for each procedure was 45±10 minutes and average hospital stay was 4 days. No patient needed readmission for any complication, but 3 patients came back for minor bleeding, 3 patients for increasing frequency of defecation and 1 patient for persistent anal pain where no definite cause was detected. At 6 months follow up significant improvement in Longo's ODS score, constipation score and quality of life was observed. Mean Longo’s ODS score was 15.75±1.98 and 7.05±5.70 at preoperative and six months post operative folowup respectively (p=&lt;0.001). Conclusion: STARR may be a safe and effective treatment modality for ODS due to internal rectal prolapse or rectocele, if done with appropriate indication and adequate skill. Patient selection is crucial point in achieving better postoperative outcome. Long term postoperative follow up is needed to make clear cut comment on STARR procedure for internal rectal prolapse or rectocele associated ODS. J Rang Med Col. September 2024; Vol. 9, No. 2: 38-43

The Diagnosis and Evolution of Patients with LARS Syndrome: A Five-Year Retrospective Study from a Single Surgery Unit.

The aim of the study was to assess the diagnosis and evolution of low anterior rectal resection syndrome (LARS) in patients admitted to a tertiary surgical center in Romania. From 120 patients initially included in the analysis, after applying the exclusion criteria, we selected 102 patients diagnosed and operated on for neoplasm of the upper, middle, and lower rectum for which resection and excision (partial or total) of mesorectum was associated. All the patients we treated in the general surgery department of the County Emergency Hospital of Craiova within a time frame of 5 years (1 October 2017-1 September 2022), and all experienced at least one symptom associated with LARS. The group included 68 men and 34 women aged between 35 and 88, who were followed-up for at least 2 years. Patients with progression of neoplastic disease, with advanced neurological disease, and those who died less than 2 years after surgery were excluded. The overall incidence varied by gender, site of the tumor (requiring a certain type of surgery), and anastomotic complications, and it was directly proportional to the time interval between resection and restoration of continuity of digestion. Obesity, size of the remaining rectum, total excision of the mesorectum, anastomotic complications, and prolonged ileostomy time are cofactors in the etiology of LARS. The LARS score decreased in most patients during the 2-year follow-up, although there were a small number of patients in whom the decrease was insignificant. The persistence of major LARS at 6 months after surgery may predict the need for a definitive colostomy.

Impact of team experience on robot-assisted surgery for rectal cancer: A comparative study.

The robotic surgical team in the operating room plays an important role in determining the outcome of a robotic approach. This study aimed to compare the outcomes of 2 hospitals with different levels of expertise in robot-assisted rectal cancer surgery. This retrospective study analyzed 195 patients who underwent robot-assisted rectal resection at 2 referral centers for the treatment of rectal cancer between March 2018 and December 2021. In total, 195 patients had undergone robotic rectal cancer surgery: 95 performed by an expert team, and 100 by a novel team. The expert team performed more low anterior resections (55.8%) than the novel team (33%) (P = .001), and the total operative time varied significantly between the groups (P < .001). The novel team's operative time was 135 minutes longer than the expert team's. The expert team had no conversions to open surgery, while the novel team had an 8% conversion rate (P = .007). In this study, overall morbidity was 45.3% among patients treated by the expert team versus 38% among those treated by the novice team (P = .304). Severe complications (Clavien-Dindo grade > IIIB) occurred at a rate of 10% in both groups. Incomplete mesorectal excision was observed in 3.2% of the expert team's patients versus 4.2% of the novice team's (P = .65). The expert team achieved a shorter operative time and less conversion to open surgery. However, the morbidity and pathological outcomes were comparable between the teams. The introduction of robotic surgery in a team with early-stage surgical experience was safe.

Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).

Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses. From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications. In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146days (range 9-483days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications. This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up.

A novel technique for the construction of an end ileostomy to prevent stoma outlet obstruction after rectal resection and total colectomy: a single-center retrospective study.

Stoma outlet obstruction (SOO) is an early postoperative complication of rectal cancer. We devised a novel surgical technique: end-ileostomy, to reduce SOO. Here, we describe the surgical technique used for constructing an end ileostomy and assess its impact on SOO. The subjects of this retrospective study were 78 patients who underwent low anterior resection or total colectomy with a defunctioning ileostomy (DI) between 2018 and 2022. The surgical procedure for end ileostomy can be summarized as follows: First, the ileum was separated using a linear stapler, approximately 30cm from the Bauhin valve; then the opposite sides of the mesentery of the oral and anal ilea were sutured; and finally, end ileostomy was performed using standard techniques. End and loop ileostomies were performed in 34 and 44 patients, respectively. We assessed the independent risk factors for SOO. SOO occurred in 12 patients (15.3%): 1 (2.9%) with an end ileostomy and 11 (25%) with a loop ileostomy. Multivariate analysis identified loop ileostomy as an independent risk factor for SOO (p = 0.037). End ileostomy construction is a useful and safe technique for reducing the incidence of SOO in defunctioning ileostomies following rectal resection.

Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes.

Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery. A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st-40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes. More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001). As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced.

The therapy of anastomotic leaks after rectal resections for rectal cancer using endoscopic vacuum therapy and internal drainage – a single centre experience

The therapy of anastomotic leaks after rectal resections for rectal cancer using endoscopic vacuum therapy and internal drainage – a single centre experience

A COMPARATIVE STUDY ON THE OUTCOME OF ILEOSTOMY VERSUS COLOSTOMY FOR TEMPORARY DIVERSION OF RECTAL ANASTOMOSIS

Temporary diversion with a stoma is often required in patients undergoing rectal resection for rectal cancer to minimize anastomotic complications. Loop ileostomy and loop colostomy are the two common options for fecal diversion. Despite their widespread use, the comparative outcomes regarding morbidity and complications of these procedures, especially in the context of temporary diversion, remain debatable. Objective: To compare the outcomes of loop ileostomy and loop colostomy for temporary rectal diversion in cancer patients undergoing rectal resection. Methods: A prospective study was conducted in the General Surgery Department of Nishtar Hospital, Multan from June 2024 to November 2024. A total of 150 rectal cancer patients undergoing anterior resection were included in the study. Patients were divided into two groups; Group A included 75 patients undergoing loop ileostomy and Group B included 75 patients undergoing loop colostomy. The primary outcome was to perform a comparison between morbidity outcomes after stoma formation and closure between both procedures. Patients were followed up after every 2-4 weeks in OPD after stomal construction and reversal. Results: After stomal construction, the incidence of complications between both groups was similar. Overall morbidity occurred in 23 patients (30.6%) in group A and 21 patients (28%) in group B. The parastomal hernia was the most common complication in the study population in 31 patients (20.6%), the difference in both groups was insignificant (20% vs 21.3%) (p=0.78). After the stomal reversal, 4 (8%) in group A and 1 (1.9%) in group B had anastomotic leaks, however, the difference was insignificant (p=0.19). 50 (66.7%) patients in the ileostomy group and 51 (68%) patients in the colostomy group underwent stoma reversal. Complications after reversal were similar with the most common complication being wound infection (14 vs 7.9%) (p=0.53%). Conclusion: The outcomes of loop ileostomy and loop colostomy for temporary diversion of rectal anastomosis in patients with rectal cancer were comparable. Larger, randomized studies are needed to verify our findings.

Usefulness of participation of endoscopic surgical skill qualification system-qualified surgeons in laparoscopic high anterior resection.

A technical qualification system was established by the Japanese Society of Endoscopic Surgery in 2004, and its effectiveness in low anterior resection (LAR) has been reported. We herein performed a subgroup analysis of the effectiveness of the participation of technically qualified surgeons in laparoscopy-assisted high anterior resection (HAR), a procedure used for the technical qualification of surgeons. The EnSSURE study enrolled 3188 patients who underwent laparoscopic rectal resection for rectal cancer between January 2014 and December 2016 at 56 Japanese hospitals. The outcomes of HAR were compared between groups with and without the participation of technically qualified surgeons. The background of the two groups were equalized by propensity score matching. In the group with the participation of qualified surgeons, the operative time was significantly shorter (p = .0427), more lymph nodes were dissected (p = .0207), and the conversion rate to open surgery was lower (p = .0016); however, no significant difference was observed in blood loss (p = .0616), the R0 resection rate (p = 1.00), intraoperative complication rate (p = .160), postoperative complication rate (p = 1.00), or reoperation rate (p = .6999) between the two groups. Furthermore, no significant difference was noted in long-term outcomes (recurrence-free survival (p = .275) or overall survival (p = .941)). In HAR, the technical benefits of the participation of qualified surgeons was limited to a shorter operative time and lower conversion rate. Nevertheless, the qualification is unique in that it predicts the usefulness of reducing complications in more technically challenging procedures when its effectiveness in LAR is considered.

Comparison of robotic assisted and laparoscopic radical resection for rectal cancer with or without left colic artery preservation

The preservation of the left colic artery (LCA) during rectal cancer resection remains a topic of controversy, and there is a notable absence of robust evidence regarding the outcomes associated with LCA preservation. And the advantages of robotic-assisted laparoscopy (RAL) surgery in rectal resection remain uncertain. The objective of this study was to assess the influence of LCA preservation surgery and RAL surgery on intraoperative and postoperative complications of rectal cancer resection. Patients who underwent laparoscopic (LSC) or RAL with or without LCA preservation resection for rectal cancer between April 2020 and May 2023 were retrospectively assessed. The patients were categorized into two groups: low ligation (LL) which with preservation of LCA and high ligation (HL) which without preservation of LCA. A one-to-one propensity score-matched analysis was performed to decrease confounding. The primary outcome was operative findings, operative morbidity, and postoperative genitourinary function. A total of 612 patients were eligible for this study, and propensity score matching yielded 139 patients in each group. The blood loss of the LL group was significantly less than that of the HL group (54.42 ± 12.99 mL vs. 65.71 ± 7.37 mL, p<0.001). The urinary catheter withdrawal time in the LL group was significantly shorter than that in the HL group (4.87 ± 2.04 d vs. 6.06 ± 2.43d, p<0.001). Anastomotic leakage in the LL group was significantly lower than that in HL group (1.44% vs. 7.91%, p = 0.011). The rate of urinary dysfunction and sexual dysfunction in LL group is both significantly lower than HL group. Blood loss and number of harvested lymph nodes (LNs) of both RAL subgroups in LL and HL groups were significantly more than that in LSC subgroups. The anastomotic leakage in the RAL subgroup of HL group was significantly lower than that in LSC subgroup (0% vs. 14.89%, p = 0.018). LCA preservation surgery for rectal cancer may help reduce the blood loss, urinary catheter withdrawal time, the rate of anastomotic leakage and ileus, and postoperative genitourinary function outcomes. RAL can reduce the probability of blood loss and improve harvest LNs in patients with rectal cancer.

Defunctioning Ileostomy After Low Anterior Resection of Rectum: Morbidity Related to Fashioning and Closure.

Background and Objectives: The aim of this study was to assess any predisposing factors to the morbidity of fashioning and reversal of diverting ileostomy in a prospective cohort of patients who have undergone TME and low colo-rectal or colo-anal anastomosis for rectal cancer. Materials and Methods: Consecutive patients with rectal cancer undergoing low anterior resection and a defunctioning loop ileostomy in three surgical units from 2016 to 2020 were included in the study and retrospectively analyzed. Results: One hundred eighty-two patients from three centres were included. Ileostomy-related mortality was 0.5%, attributed to renal failure.. Ileostomy-related morbidity was 46%. Postoperative ileus was seen in 37.4%, and dehydration in 18.8% of the patients. The readmission rate for ileostomy-related reasons was 15.4%. Stoma care was problematic in 15.7% or poor in 7% of the cases. Advanced age, male gender and obesity were independent risk factors for ileostomy-related morbidity. Ileostomy was reversed in 165 patients. The morbidity in 165 patients was 16%. Ileus was seen in 10.3%, anastomotic leak in 4.8% and wound infection in 12.7% of the cases. One patient died because of an anastomotic leak. No predisposing factors that affect the outcomes of ileostomy closure were identified. Conclusions: Diverting ileostomy-related morbidity is high. Life threatening dehydration and renal failure from ileus is more commonly seen in elderly, male and obese patients and should be anticipated. Ileostomy closure-related morbidity is low.

Rectal Eversion as an Anus-sparing Technique in Laparoscopic Low Anterior Resection With Double Stapling Anastomosis: Long-term Functional Results.

Rectal eversion (RE) is a natural orifice specimen extraction (NOSE) method that allows anus-sparing resection in very low rectal tumors. This study aims to share the long-term results of RE in laparoscopic rectal resection performed with double stapling anastomosis. A single-center retrospective cohort study was conducted for patients who underwent laparoscopic low anterior resection with RE. Age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, type of surgery, distance of the tumor to the dentate line, specimen extraction site, cancer stage, preoperative chemoradiotherapy, postoperative complications, and postoperative clinical follow-up findings were recorded. Incontinence was assessed using the Wexner score (WS). Low anterior resection syndrome (LARS) is determined by the LARS score. A 7-point Likert scale was used to evaluate the satisfaction of the patients. A total of 17 patients underwent resection by RE for rectal tumors. Of the 11 patients included in the study, 4 were female and 7 were male. The mean age was 66.09±15.04 years. The mean follow-up was 64.18±16.83 months. The mean tumor diameter was 3.1cm (range: 0.9 to 7.2cm). The mean distance of the tumor from the dentate line was 2.7cm (range: 1.2 to 5.6cm). No anastomotic leak was observed in any patient. One patient had an anastomotic stenosis and was treated with balloon dilatation. The median LARS score was 16 (range 0 to 32) and 64% of the patients had no LARS. Two patients had minor LARS and 2 patients had major LARS. The median Wexner score was 3.5 (range 0 to 14). The median Likert scale was 7 (range 5 to 7). It was found that 55% of the patients were extremely satisfied, 18% were satisfied, and 27% were slightly satisfied with their surgery. There were no dissatisfied patients. RE is a safe NOSE technique in laparoscopic double stapling anastomosis for rectal resection. There is a high level of long-term patient satisfaction with anus-sparing procedures via RE, even in the presence of various symptoms.