[A procedure to assist achievement of total mesorectal excision through the extending intersphincteric plane].
OBJECTIVE
To investigate the value of assisted achievement total mesorectal excision (TME) through the extending intersphincteric plane.


METHODS
From February 2006 to April 2010, 65 patients with low rectal cancer underwent assisted implementing TME through the extending intersphincteric plane under direct vision and achieved sphincter preservation. The clinical data was summarized and analyzed retrospectively. Follow-up visits were conducted on complications and oncological outcomes.


RESULTS
The mean operation time was (245 ± 42) minutes, and the mean intraoperative blood loss was (114 ± 76) ml. There was no postoperative mortality. Postoperative complications included 2 cases of anastomotic leak, 13 cases of anastomotic stenosis, 2 cases of early postoperative inflammatory ileus, 1 case of urinary tract infection, and 1 case of incision infection. Distal margins and circumferential resection margin of all specimens were negative. For pathological stage, there were 26 cases at stage pTNMI, 17 cases at stage pTNMII and 22 cases at stage pTNMIII. The mean follow-up time was (47.9 ± 18.9) months. 10 patients were lost to follow up, 15 cases had distant metastasis or local recurrence in, and 8 cases died of tumor metastasis at the latest follow up. Local recurrence occurred in 3 cases, including recurrence in presacral region, metastasis of lymph node at the left side in pelvis cavity, and metastasis at the sacrum at 35, 36, and 52 months postoperatively. There was no anastomotic recurrence. Log-rank survival analysis showed 5-year cumulative survival rate was 100%, 93.3%, and 63.1% in TNM stage I, II, and III, respectively. The cumulative disease-free survival rate was 96.2%, 83.3%, 44.8% in TNM stage I, II, and III, respectively.


CONCLUSIONS
It has a good oncological effect and was an advantageous procedure to assist achievement total mesorectal excision (TME) through the extending intersphincteric plane as surgeons encountered with difficulties from transabdominal TME.
Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Chang
C
Xu
Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China. Email: song88901@foxmail.com.
Hua-yu
HY
Song
Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Xiang-bin
XB
Wu
Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Jian-hui
JH
Cai
Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
Jin-lei
JL
Li
D000368:Aged; D001003:Anal Canal / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies