Anus-preserving rectectomy via telescopic colorectal mucosal anastomosis for low rectal cancer: Experience from a Chinese cohort

AIM: To investigate the safety and efficacy of anus-preserving rectectomy via telescopic colorectal mucosal anastomosis (TCMA) for low rectal cancer. METHODS: From August 1993 to October 2012, 420 patients including 253 males and 167 females with low rectal cancer underwent transabdominal and transanal anterior resection, followed by TCMA. The distance be-tween the anus and inferior margin of the tumor ranged from 5 to 7 cm, and was 5 cm in 6 patients, 6 cm in 127, and 7 cm in 287 patients. Tumor-node-metastasis staging showed that 136 patients had stage Ⅰ, 252 had stage Ⅱ and 32 had stage Ⅲ. Fifty-six patients with T3 or over received preoperative neoadjuvant chemoradio-therapy. RESULTS: The postoperative follow-up rate was 91.9% (386/420) with a median time of 6.4 years. All 420 pa-tients underwent radical resection. No postoperativedeath occurred. Postoperative complications included anastomotic leakage in 13 (3.1%) patients and anas-tomotic stenosis in 7 (1.6%). The local recurrence rate after surgery was 6.2%, the hepatic metastasis rate was 13.2% and the pulmonary metastasis rate was 2.3%. The 5-year survival rate was 74.0% and the disease-free survival rate was 71.0%. Kirwan classification showed that continence was good in 94.4% of patients with stage I when scored 12 mo after resection. CONCLUSION: TCMA for patients with low rectal cancer leads to better quality of life and satisfactory defecation function, and lowers anastomotic leakage occurrence, and might be one of the safe operative procedures in anus-preserving rectectomy.

Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions

AIM:To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.METHODS:From March 2010 to June 2014, 30 patients(14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection.The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases.In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0.Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut.Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor.For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum.The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum.RESULTS:For the present cohort of 30 cases,the mean operative time was 178 min,with an average of 13 positive lymph nodes detected.One case of postoperative anastomotic leak was observed,requiring temporary colostomy,which was closed and recovered3 mo later.The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases.Twelve months after surgery,94.4%patients achieved anal function Kirwan grade 1,indicating that their analfunction returned to normal.The patients were followed up for 1-36 mo,with an average of 23 mo.There was no local recurrence,and 17 patients survived for>3years(with a survival rate of 100%).CONCLUSION:Laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.