Treatment for Male Patients with Low Rectal Cancer by Means of Laparoscopic Total Mesorectal Excision and Per Anum Rectal Pull-Type of Anastomosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Hongbo , YANG An , FENG Yunzhang , ZHANG Guitang , LIU Qi.

The Second Department of General Surgery, Handan Central Hospital， Handan 056002, Hebei Province, China;

Corresponding author：

Keywords：

Low rectal cancer; Laparoscopy; Total mesorectal; Pull-through resection; Stapler

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Objective To study the effect of laparoscopic total mesorectal excision and per anum rectal pull-type of anastomosis on male patients with low rectal cancer. Methods The successful experiences of anus saving operation on 23 male patients with low rectal cancer were summarized. Results A laparoscopic total mesorectal excision technique was used, with the full separation of the rectum at the bottom. After pulling out the distal rectum together with the cancer from the anus, the transection of the proximal tumor was performed. The end-to-end anastomosis of rectum and descending colon was performed by tubular stapler. Anus was reserved successfully in the 23 cases. There was no left-tumor stump after surgery detected by postoperative pathological examinations, no anastomotic leakage, and no operative death. Conclusions To the relatively narrow male pelvis, laparoscopic total mesorectal excision and per anum rectal pull-through resection and anastomosis is safe and reliable for anus saving in low rectal cancer. It can simplify the operation, and raise the success rate of sphincter preserving in surgery of low rectal cancer.

Citation： LIU Hongbo,YANG An,FENG Yunzhang,ZHANG Guitang,LIU Qi.. Treatment for Male Patients with Low Rectal Cancer by Means of Laparoscopic Total Mesorectal Excision and Per Anum Rectal Pull-Type of Anastomosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(11): 1179-1182. doi: Copy

1.	No authors listed. World progress in surgery-management of adenocarcinoma of the low rectum [J]. World J Surg, 1992; 16(3): 428-515.
2.	杨世昆, 方登华, 刘斌. 腹腔镜直肠癌根治术的应用 [J]. 中国内镜杂志, 2002; 8(3): 109-110.
3.	于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007; 14(5): 524-529.
4.	Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial [J]. Lancet, 2005; 365(9472): 1718-1726.
5.	Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
6.	汪建平. 重视结直肠癌外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007; 14(6): 625-627.
7.	郑民华. 腹腔镜结直肠癌手术的原则与评价 [J]. 中华外科杂志, 2005; 43(17): 1105-1108.
8.	郑民华. 腹腔镜结直肠癌手术的现状和未来 [J]. 肿瘤学杂志, 2009; 15(2): 98-100.
9.	唐宗江. 直肠全系膜切除并直肠癌保肛手术 [J]. 大肠肛门病外科杂志, 2000; 6(1): 10-13.
10.	谭华, 韩振强. 直肠癌498例临床分析 [J]. 中国综合临床, 2001; 17(8): 589-590.
11.	Fukunaga M, Kidokoro A, Iba T, et al. Laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal cancer [J]. Surg Today, 2005; 35(7): 598-602.
12.	吕新生, 韩明. 胃肠道外科 [M]. 长沙: 湖南科学技术出版社, 1998: 731.
13.	Andreola S, Leo E, Belli F, et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis [J]. Dis Colon Rectum, 1997; 40(1): 25-29.
14.	万远廉, 潘义生. 低位直肠癌的保肛术式 [J]. 中国实用外科杂志, 2005; 25(3): 184-185.
15.	高友福, 姜波健, 孙荣勋, 等. 进展期结直肠癌淋巴转移规律的临床研究 [J]. 中国普外基础与临床杂志, 2000; 7(1): 27-29.
16.	刘宝善, 燕锦, 左明, 等. 拖出型Welch法直肠癌超低位切除术 [J]. 中华普通外科杂志, 2000; 15(7): 399-401.
17.	刘宝善. 直肠癌超低位切除的理论基础与临床效果 [J]. 中国普外基础与临床杂志, 2001; 8(1): 38-39.
18.	涂建成, 李建伟, 方健, 等. 腹腔镜辅助下低位直肠癌根治术21例体会 [J]. 中国普外基础与临床杂志, 2009; 16(10): 812-813.
19.	Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial [J]. Lancet Oncol, 2005; 6(7): 477-484.
20.	Salerno G, Daniels IR, Heald RJ. From bench to bed side: The concept of total mesorectal excision for rectal cancer [J]. EurSurg, 2005; 37(4): 238-244.
21.	Nesbakken A, Nygaard K, Westerheim O, et al. Local recurrence after mesorectal excision for rectal cancer [J]. Eur J Surg Oncol, 2002; 28(2): 126-134.
22.	Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992; 16(5): 848-857.
23.	周总光. 微创化全直肠系膜切除保肛治疗低位直肠癌: 机遇与挑战 [J]. 中国普外基础与临床杂志, 2003; 10(2): 100-102.
24.	李立. 结直肠癌外科应用技术的规范与创新(四) [J]. 中国普外基础与临床杂志, 2006; 13(4): 461-468.
25.	卿三华, 巴明臣. 我国腹腔镜直肠癌根治术的现状和展望 [J]. 中国普外基础与临床杂志, 2005; 12(6): 540-541.
26.	胡继康, 陈维鹏, 韩乃刚, 等. 现代肿瘤外科学 [M]. 北京: 中国科技出版社, 1994: 392.
27.	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.

1. No authors listed. World progress in surgery-management of adenocarcinoma of the low rectum [J]. World J Surg, 1992; 16(3): 428-515.
2. 杨世昆, 方登华, 刘斌. 腹腔镜直肠癌根治术的应用 [J]. 中国内镜杂志, 2002; 8(3): 109-110.
3. 于永扬, 杨烈, 周总光, 等. 腹腔镜全直肠系膜切除保肛术后生活质量评估 [J]. 中国普外基础与临床杂志, 2007; 14(5): 524-529.
4. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial [J]. Lancet, 2005; 365(9472): 1718-1726.
5. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer [J]. N Engl J Med, 2004; 350(20): 2050-2059.
6. 汪建平. 重视结直肠癌外科手术患者术后生存质量的提高 [J]. 中国普外基础与临床杂志, 2007; 14(6): 625-627.
7. 郑民华. 腹腔镜结直肠癌手术的原则与评价 [J]. 中华外科杂志, 2005; 43(17): 1105-1108.
8. 郑民华. 腹腔镜结直肠癌手术的现状和未来 [J]. 肿瘤学杂志, 2009; 15(2): 98-100.
9. 唐宗江. 直肠全系膜切除并直肠癌保肛手术 [J]. 大肠肛门病外科杂志, 2000; 6(1): 10-13.
10. 谭华, 韩振强. 直肠癌498例临床分析 [J]. 中国综合临床, 2001; 17(8): 589-590.
11. Fukunaga M, Kidokoro A, Iba T, et al. Laparoscopy-assisted low anterior resection with a prolapsing technique for low rectal cancer [J]. Surg Today, 2005; 35(7): 598-602.
12. 吕新生, 韩明. 胃肠道外科 [M]. 长沙: 湖南科学技术出版社, 1998: 731.
13. Andreola S, Leo E, Belli F, et al. Distal intramural spread in adenocarcinoma of the lower third of the rectum treated with total rectal resection and coloanal anastomosis [J]. Dis Colon Rectum, 1997; 40(1): 25-29.
14. 万远廉, 潘义生. 低位直肠癌的保肛术式 [J]. 中国实用外科杂志, 2005; 25(3): 184-185.
15. 高友福, 姜波健, 孙荣勋, 等. 进展期结直肠癌淋巴转移规律的临床研究 [J]. 中国普外基础与临床杂志, 2000; 7(1): 27-29.
16. 刘宝善, 燕锦, 左明, 等. 拖出型Welch法直肠癌超低位切除术 [J]. 中华普通外科杂志, 2000; 15(7): 399-401.
17. 刘宝善. 直肠癌超低位切除的理论基础与临床效果 [J]. 中国普外基础与临床杂志, 2001; 8(1): 38-39.
18. 涂建成, 李建伟, 方健, 等. 腹腔镜辅助下低位直肠癌根治术21例体会 [J]. 中国普外基础与临床杂志, 2009; 16(10): 812-813.
19. Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial [J]. Lancet Oncol, 2005; 6(7): 477-484.
20. Salerno G, Daniels IR, Heald RJ. From bench to bed side: The concept of total mesorectal excision for rectal cancer [J]. EurSurg, 2005; 37(4): 238-244.
21. Nesbakken A, Nygaard K, Westerheim O, et al. Local recurrence after mesorectal excision for rectal cancer [J]. Eur J Surg Oncol, 2002; 28(2): 126-134.
22. Heald RJ, Karanjia ND. Results of radical surgery for rectal cancer [J]. World J Surg, 1992; 16(5): 848-857.
23. 周总光. 微创化全直肠系膜切除保肛治疗低位直肠癌: 机遇与挑战 [J]. 中国普外基础与临床杂志, 2003; 10(2): 100-102.
24. 李立. 结直肠癌外科应用技术的规范与创新(四) [J]. 中国普外基础与临床杂志, 2006; 13(4): 461-468.
25. 卿三华, 巴明臣. 我国腹腔镜直肠癌根治术的现状和展望 [J]. 中国普外基础与临床杂志, 2005; 12(6): 540-541.
26. 胡继康, 陈维鹏, 韩乃刚, 等. 现代肿瘤外科学 [M]. 北京: 中国科技出版社, 1994: 392.
27. 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment for Male Patients with Low Rectal Cancer by Means of Laparoscopic Total Mesorectal Excision and Per Anum Rectal Pull-Type of Anastomosis

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