Clinical Research of Small Caliber Stapler Applying in Anterior Resection of Ultra-Low Rectal Cancer with Anal Sphincter Preservation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Zhi , YUAN Long , XU Benling , WAN Xiangbin , HAN Guangsen.

Department of General Surgery, The Henan Tumor Hospital, Zhengzhou 450003, China;

Corresponding author：

Keywords：

Rectal neoplasm; 　Stapler; 　Anus; Surgical procedures

Video：

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Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation. Methods A retrospective analysis of the data of 60 cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006 and June 2009 were undertaken. The 60 patients were divided into two groups, each group included 30 cases. One group adopted 33 mm stapler and another group adopted 29 mm stapler, and then the profiles of medi-operation, post-operation, and prognosis were assessed. Results Time of simple anastomose in operation was (9.0±3.3) min in 33 mm stapler group and (6.0±2.6) min in 29 mm stapler group, and there was significant difference between them (P=0.022 5). There were 6 cases needed to be restored because of lesion during operation or dys-anastomosis in 33 mm stapler group, while 2 cases in 29 mm stapler group, there was significant difference between them (P=0.030 1). No significant differences were observed between the two groups in terms of the time for operation, leakage, bleeding, stenosis, anastomotic recurrence, and fecal incontinence after operation or length of stay. Conclusion The application of 29 mm stapler not only can shorten time for anastomose and step down the degree of difficulty, but also dosen’t increase stenostomia and other complications.

Citation： LI Zhi,YUAN Long,XU Benling,WAN Xiangbin,HAN Guangsen.. Clinical Research of Small Caliber Stapler Applying in Anterior Resection of Ultra-Low Rectal Cancer with Anal Sphincter Preservation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(11): 1175-1178. doi: Copy

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2.	Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992； 16(5): 848-857.
3.	Andreola S, Leo E, Belli F, et al. Adenocarcimoma of the lower third of the rectum surgically treated with a<10-MM distal clearance: preliminary results in 35 NO patients [J]. Surg Oncol, 2001； 8(7): 611-615.
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5.	Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision [J]. Dis Colon Rectum, 2001； 44(4): 473-483; discussion 483-486.
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7.	Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer [J]. Br J Surg, 2001； 88(3): 400-404.
8.	Sato H, Maeda K, Hanai T, et al. Modified double-stapling technique in low anterior resection for lower rectal carcinom [J]. Surg Today, 2006; 36(1)： 30-36.
9.	Asao T, Kuwano H, Nakamura J, et al. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses [J]. Dis Colon Rectum, 2002; 45(1)： 137-139.
10.	Roumen RM, Rahusen FT, Wijnen MH, et al. “Dog ear” for mation after double-stapled low anterior resection as a risk factor for anastomotic disruption [J]. Dis Colon Rectum, 2000; 43(4)： 522-525.
11.	Mkel JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis [J]. Dis Colon Rectum, 2003； 46(5)： 653-660.
12.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence？ [J]. Br J Surg, 1982； 69(10)： 613-616.
13.	Peeters KC， Tollenaar RA， Marijnen CA， et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer [J]. Br J Surg, 2005； 92(2): 211-216.
14.	Detry RJ, Kartheuser A, Delriviere L, et al. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team [J]. Surgery, 1995； 117(2): 140-145.
15.	汪建平, 吴小剑, 宋新明, 等. 不同时期低位直肠癌根治手术保肛率的变化及其因素分析 [J]. 中华胃肠外科杂志, 2006； 9(2): 107-110.
16.	李东华, 郁宝铭, 郑民华, 等. 低位前切除术后吻合口瘘的探讨 [J]. 中华胃肠外科杂志, 2000； 3(4): 243-244.
17.	刘萌华. 低位直肠癌吻合口瘘和直肠阴道瘘的预防与处理 [J]. 中国实用外科杂志, 2007； 27(6): 448-450.
18.	Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? [J]. Dis Colon Rectum, 2004； 47(3): 291-296.
19.	Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised) [J]. Dis Colon Rectum， 2005； 48(3): 411-423.
20.	Terzi C, Unek T, Saˇgol O, et al. Is rectal washout necessary in anterior resection for rectal cancer? A prospective clinical study [J]. World J Surg, 2006； 30(2): 233-241.
21.	Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [J]. Dis Colon Rectum, 2004； 47(10): 1706-1710.
22.	Fukunaga Y, Higashino M, Tanimura S, et al. New technique for rectal division in laparoscopic anterior resection--with video [J]. World J Surg, 2008； 32(9): 2095-2100.
23.	郑斌. 中低位直肠癌 TME 并双吻合器吻合术后吻合口效果观察 [J]. 中国普外基础与临床杂志, 2009； 16(6): 481-482.
24.	Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up [J]. Dis Colon Rectum, 2004； 47(10): 1578-1585.
25.	Bretagnol F, Troubat H, Laurent C, et al. Long-term functional results after sphincter-saving resection for rectal cancer [J]. Gastroenterol Clin Biol, 2004； 28(2): 155-159.

1. 郁宝铭. 结直肠癌外科治疗的现状和展望 [J]. 中国普外基础与临床杂志, 2008; 15(9): 631-636.
2. Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992； 16(5): 848-857.
3. Andreola S, Leo E, Belli F, et al. Adenocarcimoma of the lower third of the rectum surgically treated with a<10-MM distal clearance: preliminary results in 35 NO patients [J]. Surg Oncol, 2001； 8(7): 611-615.
4. Kapipeijn E, van De Velde CJ. European trials with total mesorectal excision [J]. Semin Surg Oncol, 2000； 19(4): 350-357.
5. Killingback M, Barron P, Dent OF. Local recurrence after curative resection of cancer of the rectum without total mesorectal excision [J]. Dis Colon Rectum, 2001； 44(4): 473-483; discussion 483-486.
6. Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifications, and observation [J]. Ann Surg， 1990； 211(6): 745-751; discussion 751-752.
7. Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer [J]. Br J Surg, 2001； 88(3): 400-404.
8. Sato H, Maeda K, Hanai T, et al. Modified double-stapling technique in low anterior resection for lower rectal carcinom [J]. Surg Today, 2006; 36(1)： 30-36.
9. Asao T, Kuwano H, Nakamura J, et al. Use of a mattress suture to eliminate dog ears in double-stapled and triple-stapled anastomoses [J]. Dis Colon Rectum, 2002; 45(1)： 137-139.
10. Roumen RM, Rahusen FT, Wijnen MH, et al. “Dog ear” for mation after double-stapled low anterior resection as a risk factor for anastomotic disruption [J]. Dis Colon Rectum, 2000; 43(4)： 522-525.
11. Mkel JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis [J]. Dis Colon Rectum, 2003； 46(5)： 653-660.
12. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence？ [J]. Br J Surg, 1982； 69(10)： 613-616.
13. Peeters KC， Tollenaar RA， Marijnen CA， et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer [J]. Br J Surg, 2005； 92(2): 211-216.
14. Detry RJ, Kartheuser A, Delriviere L, et al. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team [J]. Surgery, 1995； 117(2): 140-145.
15. 汪建平, 吴小剑, 宋新明, 等. 不同时期低位直肠癌根治手术保肛率的变化及其因素分析 [J]. 中华胃肠外科杂志, 2006； 9(2): 107-110.
16. 李东华, 郁宝铭, 郑民华, 等. 低位前切除术后吻合口瘘的探讨 [J]. 中华胃肠外科杂志, 2000； 3(4): 243-244.
17. 刘萌华. 低位直肠癌吻合口瘘和直肠阴道瘘的预防与处理 [J]. 中国实用外科杂志, 2007； 27(6): 448-450.
18. Agaba EA. Does rectal washout during anterior resection prevent local tumor recurrence? [J]. Dis Colon Rectum, 2004； 47(3): 291-296.
19. Tjandra JJ, Kilkenny JW, Buie WD, et al. Practice parameters for the management of rectal cancer (revised) [J]. Dis Colon Rectum， 2005； 48(3): 411-423.
20. Terzi C, Unek T, Saˇgol O, et al. Is rectal washout necessary in anterior resection for rectal cancer? A prospective clinical study [J]. World J Surg, 2006； 30(2): 233-241.
21. Maeda K, Maruta M, Hanai T, et al. Irrigation volume determines the efficacy of “rectal washout” [J]. Dis Colon Rectum, 2004； 47(10): 1706-1710.
22. Fukunaga Y, Higashino M, Tanimura S, et al. New technique for rectal division in laparoscopic anterior resection--with video [J]. World J Surg, 2008； 32(9): 2095-2100.
23. 郑斌. 中低位直肠癌 TME 并双吻合器吻合术后吻合口效果观察 [J]. 中国普外基础与临床杂志, 2009； 16(6): 481-482.
24. Hida J, Yoshifuji T, Tokoro T, et al. Comparison of long-term functional results of colonic J-pouch and straight anastomosis after low anterior resection for rectal cancer: a five-year follow-up [J]. Dis Colon Rectum, 2004； 47(10): 1578-1585.
25. Bretagnol F, Troubat H, Laurent C, et al. Long-term functional results after sphincter-saving resection for rectal cancer [J]. Gastroenterol Clin Biol, 2004； 28(2): 155-159.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Research of Small Caliber Stapler Applying in Anterior Resection of Ultra-Low Rectal Cancer with Anal Sphincter Preservation

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