title: [Laparoscopic total mesorectal excision combined with intersphincteric resection for ultra-low rectal cancer].
abstract: OBJECTIVE
  To evaluate clinical outcomes after laparoscopic total mesorectal excision (TME) combined with intersphincteric resection (ISR) for ultra-low rectal tumors.
  
  
  METHODS
  Clinical data of 36 patients with ultra-low rectal tumor undergoing laparoscopic TME combined with ISR were analyzed retrospectively.
  
  
  RESULTS
  The median distance from the inferior margin of the tumor to the anal verge was 3.4 (2.0-5.0) cm. There were 33 cases of well/moderately differentiated adenocarcinoma and 3 rectal malignant villous adenoma. There were 16 patients with stage I disease, 15 with stage II A, 3 with stage III A, and 1 with III B. Postoperatively, one patient developed stenosis at the end ileostomy and 3 anastomotic leakage. After a median follow-up of 16(4-49) months, one patient developed local recurrence at the anastomosis and one case died of liver metastasis. In the 19 patients who had a minimum follow-up of one year, the bowel movements frequency ranged from 1-4 times per day, and these patients were able to withhold defecation for more than 5 minutes.
  
  
  CONCLUSIONS
  Laparoscopic TME combined with ISR can achieve oncologic clearance, sphincter preservation, and minimal invasiveness for ultra-lower rectal cancer. However, patients selection should be cautious.
authors.affiliation: Department of Laparoscopic Surgery and Anorectal Surgery, The First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China.
authors.forename: Zhen-xu
authors.initials: ZX
authors.lastname: Zhou
authors.forename: Xiao-feng
authors.initials: XF
authors.lastname: Zheng
authors.forename: Hua-yu
authors.initials: HY
authors.lastname: Song
authors.forename: Fei-zhao
authors.initials: FZ
authors.lastname: Jiang
authors.forename: Zhe-jin
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Zhi-gui
authors.initials: ZG
authors.lastname: Zuo
authors.forename: Hua-jie
authors.initials: HJ
authors.lastname: Cai
authors.forename: Xiao-jiao
authors.initials: XJ
authors.lastname: Ruan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008643:Mesentery / Q000601:surgery*; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome