Laparoscopic colon and rectal resections with intracorporeal anastomosis and trans-vaginal specimen extraction for colorectal cancer. A case series and systematic literature review.
OBJECTIVE
Intracorporeal anastomosis associated to trans-vaginal specimen extraction decreases the extent of colon mobilisation and the number and size of abdominal incisions, improving the benefits of minimally invasive surgery in female patients. The aim of this study was to evaluate the safety and effectiveness of this procedure for colorectal cancer.


METHODS
Between 2009 and 2013, 13 female patients underwent laparoscopic colon and rectal resection for colorectal cancer with intracorporeal anastomosis and trans-vaginal specimen extraction: 2 right colectomies, 1 transverse colon resection, 4 left colectomies and 6 anterior resections were performed. A MEDLINE search of publications on the presented procedure for colon neoplasms was carried out.


RESULTS
There were no intraoperative complications and no conversions. Postoperative visual analogue scale (VAS) score in the pelvis, abdomen and shoulder was moderate. In the postoperative period, we observed two colorectal anastomotic strictures, successfully treated with pneumatic endoscopic dilation. Median length of the specimen was 18.5 cm, with a median tumour size of 5.5 cm in diameter. Median number of retrieved lymph nodes was 12. All circumferential resection margins were negative. During a mean follow-up of 31 months (range, 6-62), there was neither evidence of recurrent disease nor disorders related to the genitourinary system. The aesthetic outcome was considered satisfactory in all patients. Nine studies were identified in the systematic review.


CONCLUSIONS
Our case series, according to the results of the literature, showed that intracorporeal anastomosis associated to trans-vaginal specimen extraction is feasible and safe in selected female patients.
Department of Surgery, Colorectal Surgery Unit, Hospital "S. Giovanni-Addolorata", Via dell'Amba Aradam 8, 00186, Rome, Italy, fstipa@hsangiovanni.roma.it.
Francesco
F
Stipa
Antonio
A
Burza
Rosanna
R
Curinga
Ettore
E
Santini
Pietro
P
Delle Site
Riccardo
R
Avantifiori
Marcello
M
Picchio
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010147:Pain Measurement; D012007:Rectum / Q000601:surgery*; D014621:Vagina / Q000601:surgery*