Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter: a report of 82 cases.
OBJECTIVE
To assess the feasibility and efficacy of laparoscopic total mesorectal excision (LTME) of low rectal cancer with preservation of anal sphincter.


METHODS
From June 2001 to June 2003, 82 patients with low rectal cancer underwent laparoscopic total mesorectal excision with preservation of anal sphincter. The lowest edge of tumors was below peritoneal reflection and 1.5-7 cm from the dentate line (1.5-5 cm in 48 cases, 5-7 cm in 34 cases).


RESULTS
LTME with anal sphincter preservation was performed on 82 randomized patients with low rectal cancer, and 100 % sphincter preservation rate was achieved. There were 30 patients with laparoscopic low anterior resection (LLAR) at the level of the anastomosis below peritoneal reflection and 2 cm above from the dentate line; 27 patients with laparoscopic ultralow anterior resection (LULAR) at the level of anastomoses 2 cm below from the dentate line; and 25 patients with laparoscopic coloanal anastomoses (LCAA) at the level of the anastomoses at or below the dentate line. No defunctioning ileostomy was created in any case. The mean operating time was 120 minutes (ranged from 110-220 min), and the mean operative blood loss was 20 mL (ranged from 5-120 mL). Bowel function was restored and diet was resumed on day 1 or 2 after operation. The mean hospital stay was 8 days (ranged from 5-14). Postoperative analgesics were used in 45 patients. After surgery, 2 patients had urinary retention, one had anastomotic leakage, and another 2 patients had local recurrence one year later. No interoperative complication was observed.


CONCLUSIONS
LTME with preservation of anal sphincter is a feasible, safe and minimally invasive technique with less postoperative pain and rapid recovery, and importantly, it has preserved the function of the sphincter.
Zhou
Zong-Guang
ZG
Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China. zhou767@21cn.com
Wang
Zhao
Z
Yu
Yong-Yang
YY
Shu
Ye
Y
Cheng
Zhong
Z
Li
Li
L
Lei
Wen-Zhang
WZ
Wang
Tian-Cai
TC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003672:Defecation; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000601:surgery*