title: Laparoscopic local excision and rectoanal anastomosis for rectal gastrointestinal stromal tumor: modified laparoscopic intersphincteric resection technique.
abstract: BACKGROUND
  Rectal GI stromal tumor is uncommon. Local excision with free resection margins provides adequate treatment, but extended surgery such as abdominoperineal resection has been frequently performed because of technical difficulties in the confined pelvic space.
  
  
  OBJECTIVE
  We aimed to report the technical details of a new method of local excision for rectal GI stromal tumor: the modified laparoscopic intersphincteric resection technique.
  
  
  METHODS
  This study was a retrospective analysis.
  
  
  METHODS
  This study was performed at a single institute.
  
  
  METHODS
  We included 3 patients with rectal GI stromal tumor who underwent this procedure following neoadjuvant imatinib therapy.
  
  
  METHODS
  Medial-to-lateral retroperitoneal dissection was begun near the sacral promontory, and rectal dissection while preserving autonomic nerves was performed down to the pelvic floor into the anal canal without dividing the inferior mesenteric artery. Dissection between the tumor and prostate was meticulously performed under laparoscopic magnified view. Next, circumferential connection between the laparoscopic and transanal dissections was performed through a transanal approach, and the rectum was extracted through the anus. Circular full-thickness local excision of the rectum and handsewn straight rectoanal anastomosis was performed.
  
  
  METHODS
  The safety and feasibility of this procedure were the primary outcomes measured by this study.
  
  
  RESULTS
  The median operative time was 180 minutes, and the median estimated blood loss was 115 mL. There were no conversions or intraoperative complications, and there was 1 postoperative intestinal obstruction that recovered with conservative therapy. All patients had negative resection margins (R0), including 1 pathological complete response.
  
  
  CONCLUSIONS
  The study was limited by the small number of patients.
  
  
  CONCLUSIONS
  This modified laparoscopic intersphincteric resection technique is a novel and safe method for local excision of rectal GI stromal tumors located very close to the anus (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A139).
authors.affiliation: 1Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan 2Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiyoshi
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueno
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fukunaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nagayama
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Konishi
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kuroyanagi
mesh_terms: D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D005240:Feasibility Studies; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome