Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Stapled Colo-Anal Anastomosis under Direct Vision_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CONGJin-chun , XUKun ,  CHENChun-sheng , XIAZhi-xiu , MAMing-xing , ZHANGFang-yuan

Department of Colorectal Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding author：

CHENChun-sheng, Email: chenchunsheng@sj-hospital.org

Keywords：

Laparoscope; Intersphincteric resection; Low rectal cancer

DOI：

10.7507/1007-9424.20150143

Video：

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Objective To analyze the safety and feasibility of laparoscopic intersphincteric resection with stapled colo-anal anastomosis under direct vision for low rectal cancer. Methods From January 2001 to March 2012, 138 patients were underwent intersphincteric resection for low rectal cancer, 45 cases of whom were received laparoscopic surgery and stapled colo-anal anastomosis (SCAA group), and the other 93 cases (55 open and 38 laparoscopic) of whom were received hand-sewn colo-anal anastomosis (HCAA group). The morbidity comparison only involed the data of relevant to the anastomosis. The anus functional outcomes, including those from the Saito function questionnaire and Wexner score, were compared and only involved the data of relevant to the laparoscope. Results ①The anastomotic complications rates were similar for the fistula, bleeding, and rectal mucosal prolapse (P > 0.05); the rate of anastomosis leakage and the degree of anastomotic stricture in the SCAA group were significantly lower (or milder) than those in the HCAA group (P=0.001 and P=0.022, respectively).②As for the functional results, the incidence of dyschesia in the SCAA group was significantly lower than that in the HCAA group (P=0.016), and the other 7 items of Saito function questionnaire and Wexner score were similar between these two groups (P > 0.05). Conclusions Compared with traditional intersphincteric resection for low rectal cancer, laparoscopic surgery with stapled colo-anal anastomosis could reduce the morbidity and the anus function is non-inferior to the former.

Citation： CONGJin-chun, XUKun, CHENChun-sheng, XIAZhi-xiu, MAMing-xing, ZHANGFang-yuan. Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Stapled Colo-Anal Anastomosis under Direct Vision. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(5): 535-540. doi: 10.7507/1007-9424.20150143 Copy

1.	Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours. Br J Surg, 1994, 81(9):1376-1378.
2.	陈小龙, 邓磊, 汪晓东, 等.经肛内外括约肌间切除术后肿瘤学效果及影响因素的研究进展.中国普外基础与临床杂志, 2010, 17(5):515-518.
3.	Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg, 2012, 99(5):603-612.
4.	Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection:a prospective, comparative study. Dis Colon Rectum, 2005, 48(11):2076-2079.
5.	Montedori A, Cirocchi R, Farinella E, et al. Covering ileo-or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev, 2010, 12:CD006878.
6.	Kuhry E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer:A cochrane systematic review of randomised controlled trials. Cancer Treat Rev, 2008, 34(6):498-504.
7.	吴兴桂, 井红民, 蔺桂恒, 等.经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术治疗超低位直肠癌13例.中国普外基础与临床杂志, 2008, 15(9):656-658.
8.	Lim SW, Huh JW, Kim YJ, et al. Laparoscopic intersphincteric resection for low rectal cancer. World J Surg, 2011, 35(12):2811-2817.
9.	Fujii S, Yamamoto S, Ito M, et al. Short-term outcomes of laparoscopic intersphincteric resection from a phaseⅡtrial to evaluate laparoscopic surgery for stage 0/rectal cancer:Japan Society of Laparoscopic Colorectal Surgery Lap RC. Surg Endosc, 2012, 26(11):3067-3076.
10.	Cong JC, Chen CS, Ma MX, et al. Laparoscopic intersphincteric resection for low rectal cancer:comparison of stapled and manual coloanal anastomosis. Colorectal Dis, 2014, 16(5):353-358.
11.	Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy. Dis Colon Rectum, 2004, 47(4):459-466.
12.	Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1):77-97.
13.	丛进春, 陈春生, 马明星, 等.超低位直肠癌行纵向部分括约肌切除术和经内外括约肌间切除术后肛门功能及生活质量比较.中国普外基础与临床杂志, 2014, 21(3):305-312.
14.	Sakamoto K, Okazawa Y, Takahashi R, et al. Laparoscopic intersphincteric resection using needlescopic instruments. J Minim Access Surg, 2014, 10(4):221-224.
15.	Saito N, Ito M, Kobayashi A, et al. Long-term Outcomes after Intersphincteric Resection for Low-Lying Rectal Cancer. Ann Surg Oncol, 2014, 21(11):3608-3615.
16.	Kim JC, Lim SB, Yoon YS, et al. Completely abdominal intersphincteric resection for lower rectal cancer:feasibility and comparison of robot-assisted and open surgery. Surg Endosc, 2014, 28(9):2734-2744.
17.	Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol, 2014, 21 Suppl 3:S422-S428.
18.	Fain SN, Patin CS, Morgenstern L. Use of a mechanical suturing apparatus in low colorectal anastomosis. Arch Surg, 1975, 110(9):1079-1082.
19.	Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev, 2012, 2:CD003144.
20.	Hiranyakas A, Da Silva G, Denoya P, et al. Colorectal anastomotic stricture:is it associated with inadequate colonic mobilization? Tech Coloproctol, 2013, 17(4):371-375.
21.	丛进春, 陈春生, 冯勇, 等.新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响.中国肿瘤临床, 2013, 40(23):1450-1454.
22.	Nishizawa Y, Fujii S, Saito N, et al. The association between anal function and neural degeneration after preoperative chemoradio therapy followed by intersphincteric resection. Dis Colon Rectum, 2011, 54(11):1423-1429.
23.	Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):a multicentre, randomised trial. Lancet, 2009, 373(9666):811-820.
24.	Birgisson H, Påhlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer:long-term followup of the Swedish Rectal Cancer Trial. J Clin Oncol, 2005, 23(34):8697-8705.
25.	Wong RK, Tnadan V, De Silva S, et al. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev, 2007, 2:CD002102.

1. Schiessel R, Karner-Hanusch J, Herbst F, et al. Intersphincteric resection for low rectal tumours. Br J Surg, 1994, 81(9):1376-1378.
2. 陈小龙, 邓磊, 汪晓东, 等.经肛内外括约肌间切除术后肿瘤学效果及影响因素的研究进展.中国普外基础与临床杂志, 2010, 17(5):515-518.
3. Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg, 2012, 99(5):603-612.
4. Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection:a prospective, comparative study. Dis Colon Rectum, 2005, 48(11):2076-2079.
5. Montedori A, Cirocchi R, Farinella E, et al. Covering ileo-or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev, 2010, 12:CD006878.
6. Kuhry E, Schwenk W, Gaupset R, et al. Long-term outcome of laparoscopic surgery for colorectal cancer:A cochrane systematic review of randomised controlled trials. Cancer Treat Rev, 2008, 34(6):498-504.
7. 吴兴桂, 井红民, 蔺桂恒, 等.经腹腔镜经肛门括约肌间直肠切除结肠肛管吻合术治疗超低位直肠癌13例.中国普外基础与临床杂志, 2008, 15(9):656-658.
8. Lim SW, Huh JW, Kim YJ, et al. Laparoscopic intersphincteric resection for low rectal cancer. World J Surg, 2011, 35(12):2811-2817.
9. Fujii S, Yamamoto S, Ito M, et al. Short-term outcomes of laparoscopic intersphincteric resection from a phaseⅡtrial to evaluate laparoscopic surgery for stage 0/rectal cancer:Japan Society of Laparoscopic Colorectal Surgery Lap RC. Surg Endosc, 2012, 26(11):3067-3076.
10. Cong JC, Chen CS, Ma MX, et al. Laparoscopic intersphincteric resection for low rectal cancer:comparison of stapled and manual coloanal anastomosis. Colorectal Dis, 2014, 16(5):353-358.
11. Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer:an active approach to avoid a permanent colostomy. Dis Colon Rectum, 2004, 47(4):459-466.
12. Jorge JM, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum, 1993, 36(1):77-97.
13. 丛进春, 陈春生, 马明星, 等.超低位直肠癌行纵向部分括约肌切除术和经内外括约肌间切除术后肛门功能及生活质量比较.中国普外基础与临床杂志, 2014, 21(3):305-312.
14. Sakamoto K, Okazawa Y, Takahashi R, et al. Laparoscopic intersphincteric resection using needlescopic instruments. J Minim Access Surg, 2014, 10(4):221-224.
15. Saito N, Ito M, Kobayashi A, et al. Long-term Outcomes after Intersphincteric Resection for Low-Lying Rectal Cancer. Ann Surg Oncol, 2014, 21(11):3608-3615.
16. Kim JC, Lim SB, Yoon YS, et al. Completely abdominal intersphincteric resection for lower rectal cancer:feasibility and comparison of robot-assisted and open surgery. Surg Endosc, 2014, 28(9):2734-2744.
17. Koyama M, Murata A, Sakamoto Y, et al. Long-term clinical and functional results of intersphincteric resection for lower rectal cancer. Ann Surg Oncol, 2014, 21 Suppl 3:S422-S428.
18. Fain SN, Patin CS, Morgenstern L. Use of a mechanical suturing apparatus in low colorectal anastomosis. Arch Surg, 1975, 110(9):1079-1082.
19. Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev, 2012, 2:CD003144.
20. Hiranyakas A, Da Silva G, Denoya P, et al. Colorectal anastomotic stricture:is it associated with inadequate colonic mobilization? Tech Coloproctol, 2013, 17(4):371-375.
21. 丛进春, 陈春生, 冯勇, 等.新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响.中国肿瘤临床, 2013, 40(23):1450-1454.
22. Nishizawa Y, Fujii S, Saito N, et al. The association between anal function and neural degeneration after preoperative chemoradio therapy followed by intersphincteric resection. Dis Colon Rectum, 2011, 54(11):1423-1429.
23. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016):a multicentre, randomised trial. Lancet, 2009, 373(9666):811-820.
24. Birgisson H, Påhlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer:long-term followup of the Swedish Rectal Cancer Trial. J Clin Oncol, 2005, 23(34):8697-8705.
25. Wong RK, Tnadan V, De Silva S, et al. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev, 2007, 2:CD002102.

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Laparoscopic Intersphincteric Resection for Low Rectal Cancer: Stapled Colo-Anal Anastomosis under Direct Vision

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