Clinical outcome of laparoscopic intersphincteric resection combined with transanal rectal dissection for t3 low rectal cancer in patients with a narrow pelvis

Abstract

Purpose. The purpose of this study was to analyze the safety and feasibility of laparoscopic intersphincteric resection (ISR) combined with transanal rectal dissection (TARD) for T3 low rectal cancer in a narrow pelvis. Methods. We studied 20 patients with a narrow pelvis of median body mass index 25.3 (16.9-31.2). Median observation period was 23.6 months (range 12.2-56.7). Results. Partial, subtotal, and total ISR was performed in 15, 1, and 4 patients, respectively. Median duration of TARD was 83 min (range 43-135). There were no major complications perioperatively or postoperatively. Surgical margins were histologically free of tumor cells in all patients, and there was no local recurrence. Excluding urgency, frequency of bowel movements, and incontinence status improved gradually after stoma closure. Conclusion. Laparoscopic ISR combined with TARD is technically feasible for selective T3 low rectal cancer in patients with a narrow pelvis.

Figure 1

Transanal rectal dissection for a male patient with T3 low rectal cancer. A circular incision of the rectum was performed by closing the cut end of the rectum (a). The rectum including the tumor was mobilized proximally by exposing the levator ani (b, c).

Figure 2

Laparoscopic procedure combined with transanal rectal dissection. The gauze that was placed on the dissected plane as a landmark was able to be identified through the peritoneum on the anterior side on the rectum. It was relatively easy to dissect Denonvillier's fascia and expose the seminal vesicles and prostate gland (a). On the posterior side of the rectum, it was possible to mobilize the lower rectum and mesorectum from the sacrum on the separated plane between the visceral and parietal endopelvic fascia through the anus (b). The lateral ligaments of the rectum were gradually divided with a harmonic scalpel from the inner limit of the inferior hypogastric nerve fibers. The rectum, including the total mesorectum, was completely removed from the pelvic floor (c, d).