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. 2023 Jan 18;408(1):41.
doi: 10.1007/s00423-023-02801-y.

Modified serial techniques "ASTRO" facilitated laparoscopic total mesorectal excision for ultralow-lying rectal cancer in obese male patients: how we do it (with video)

Yefeng Yin #  1 , Meng Zhuang #  1   2 , Xiyue Hu  1 , Junguang Liu  3 , Shiwen Mei  1   2 , Jianqiang Tang  4   5   6
Affiliations

Modified serial techniques "ASTRO" facilitated laparoscopic total mesorectal excision for ultralow-lying rectal cancer in obese male patients: how we do it (with video)

Yefeng Yin et al. Langenbecks Arch Surg. .

Erratum in

Abstract

Background: Laparoscopic total mesorectal excision (LaTME) is a technically challenging for ultralow-lying rectal cancer in obese male patients. Herein, we introduced modified serial techniques "ASTRO" to facilitate LaTME, and the short-term outcomes were presented.

Methods: A prospective study (NCT05067413) was conducted between December 2020 and January 2022. The modified serial surgical techniques "ASTRO" included 5 key steps: (1) Anterior peritoneal reflection (APR) dissection at the highest line along with a "n"-shaped membrane bridge; (2) suspending the APR with a purse-string suture through the bladder peritoneum to enlarge the operating space of the anterior rectal wall; (3) traction and counter-traction continuously of the rectum applied with a cotton tape around the rectum; (4) resection of the pelvic rectum on tripartition, followed by the sequence of "posterior > anterior > lateral" principle; and (5) the trans-anterior Obturator nerve gateway was adapted to transect the distal rectum. The operative data and postoperative short-term outcomes were collected.

Results: Twenty-four consecutive patients underwent this procedure successfully. The average body mass index (BMI) was 29.9±1.3. The average of tumor height from anal verge was 4.0 cm (range, 3.0-4.5 cm). The median operating time and blood loss was 217 min (range, 165-420 min) and 50 ml (range, 20-100 ml) respectively. The anterior operation space at the midsagittal plane of the pelvis inlet was increased by 2.0 ± 0.3 cm. The calculated dominant angle was 20 ± 3°. The length of stapling line was 6.8 ± 1.0 cm with 11 cases by one cartridge and 13 cases by 2 cartridges. Eight patients developed postoperative complications including 4 with anastomosis leakage (16.7%), 2 with urinary retention (8.3%), one with anastomotic stenosis (4.2%) and one with ileus (4.2%). All the complications were relatively mild and the patients recovered well.

Conclusion: Modified serial techniques "ASTRO" could expand the operating space and facilitate LaTME in obese male patients, thereby reducing the risk of conversion to open and transanal dissection.

Keywords: Laparoscopic; Obesity; Transanterior obturator nerve gateway; Ultralow rectal cancer.

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References

    1. Oguoma VM et al (2021) Prevalence of overweight and obesity, and associations with socio-demographic factors in Kuwait. BMC Public Health 21(1):667 - PubMed - PMC
    1. Kyrgiou M et al (2017) Adiposity and cancer at major anatomical sites: umbrella review of the literature. Bmj 356:j477 - PubMed - PMC
    1. Murphy G et al (2018) Serum ghrelin is associated with risk of colorectal adenocarcinomas in the ATBC study. Gut 67(9):1646–1651 - PubMed
    1. Panteleimonitis S et al (2020) Results of laparoscopic resection in high-risk rectal cancer patients. Langenbecks Arch Surg 405(4):479–490 - PubMed
    1. Bi L et al (2020) Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer. Langenbecks Arch Surg 405(2):233–239 - PubMed

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