The techniques of sphincter-saving extrasphincteric dissection and proximal segmental sphincteric excision in low rectal cancer surgery

Abstract

Objective: To define the techniques used in lower rectal cancer surgery, by transvaginal and transperineal approach; extrasphincteric dissection, proximal segmental sphincteric excision and transsphincteric rectal resection.

Material and methods: Between 2007 and 2013, 7 patients (4 female, 3 male with lower rectal cancer were operated by sphincter-saving extrasphincteric disection and proksimal sphincteric excision techniques. After completion of the rectosigmoid dissection and total mesorectal excision up to the puborectal muscle level; extrasphincteric rectal dissection, transsphincteric rectal resection and ultra-low coloanal anastomosis were performed by using the transvaginal and transperineal approach in the sublevator phase of the operation.

Results: Seven patients were operated with sublevator access for lower rectal cancer. Bowel contiunity has been provided in all patients. One patient died due to surgical complications in the early postoperative period. One patient deceveloped anastomotic leakage and there were two patients with anastomotic stricture. Circumferential resection margin and tumoral perforation were found negative in all of the patients. Tumoral deposits at the distal resection line was observed in one patient.

Conclusion: The techniques of sublevator rectal resection may be considered as an alternative sphincter-saving surgical method, especially in lower rectal cancer surgery.

Keywords: Lower rectal cancer; proximal segmental sphincteric excision; sphincter-saving extrasphincteric dissection; transsphincteric rectal resection.

Figure 1a.

Transvaginal extra-sphincteric rectal dissection in a female with lower rectal cancer. b) Transperineal extra-sphincteric rectal dissection in a male with lower rectal cancer

Figure 2a.

Trans-sphincteric rectal resection at the sublevator level in a female with lower rectal cancer. b) Transsphincteric rectal resection at the sublevator level in a male with lower rectal cancer

Figure 3a.

Distal anal segment after resection in a female with lower rectal cancer. b) Distal anal segment after resection in a male with lower rectal cancer

Figure 4a.

Transvaginal colo-anal anastomosis after resection in a female with lower rectal cancer. b) Transperineal colo-anal anastomosis after resection in a male with lower rectal cancer