title: Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions.
abstract: OBJECTIVE
  To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions.
  
  
  METHODS
  From March 2010 to June 2014, 30 patients (14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection. The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases. In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0. Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut. Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor. For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum. The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum.
  
  
  RESULTS
  For the present cohort of 30 cases, the mean operative time was 178 min, with an average of 13 positive lymph nodes detected. One case of postoperative anastomotic leak was observed, requiring temporary colostomy, which was closed and recovered 3 mo later. The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases. Twelve months after surgery, 94.4% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. The patients were followed up for 1-36 mo, with an average of 23 mo. There was no local recurrence, and 17 patients survived for > 3 years (with a survival rate of 100%).
  
  
  CONCLUSIONS
  Laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Shi-Yong
authors.initials: SY
authors.lastname: Li
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Jun-Feng
authors.initials: JF
authors.lastname: Du
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Guang
authors.initials: G
authors.lastname: Chen
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Wei
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Fu-Yi
authors.initials: FY
authors.lastname: Zuo
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Xing
authors.initials: X
authors.lastname: Dong
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Xi-Qing
authors.initials: XQ
authors.lastname: Ji
authors.affiliation: Shi-Yong Li, Gang Chen, Jun-Feng Du, Guang Chen, Xiao-Jun Wei, Wei Cui, Fu-Yi Zuo, Bo Yu, Xing Dong, Xi-Qing Ji, Qiang Yuan, Department of General Surgery, General Hospital of PLA Beijing Military Command, Beijing 100700, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D003125:Colostomy; D018572:Disease-Free Survival; D004210:Dissection; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anus-preserving rectectomy; Laparoscopic resection; Rectal neoplasms; Telescopic anastomosis