Abstract: Objective:To explore the clinical efficacy of laparoscopeassisted transanal total mesorectal excision (LaTaTME) for middlelow rectal cancer.
Methods:The retrospective crosssectional study was conducted. The clinical data of 16 patients with middlelow rectal cancer who underwent LaTaTME in the Peking University Third Hospital from August 2015 to August 2016 were collected. Sequential surgery of LaTaTME was applied to patients in the same team, with laparoscopic surgery first and then transanal surgery. Observation indicators: (1) operation and postoperative recovery situations: conversion to open surgery, anastomosis method, operation time, volume of intraoperative blood loss, intraoperative complications, time for outofbed activity, time for liquid diet intake, postoperative complications and duration of postoperative hospital stay. (2) postoperative pathological situations: length of surgical specimen, tumor diameter, distance from tumor to resected distant intestinal canal, complete degree of mesorectum, circumferential resection margin, pathological T stage, pathological N stage, number of lymph node detected and tumor cell differentiation. (3) followup. Patients in stage Ⅲ-Ⅳ of TNM stage of RC underwent postoperative adjuvant chemotherapy. Followup using outpatient examination was performed once every 3 months postoperatively to detect the patients′ survival and tumor recurrence up to December 2016. Measurement data were represented as M (range).
Results: (1) Operation and postoperative recovery situations: all the 16 patients underwent successful LaTaTME without conversion to open surgery, including 10 with colorectal anastomosis, 3 with coloncanalis analis anastomosis and 3 with permanent colostomy. Operation time and volume of intraoperative blood loss were 290 minutes (range, 215-420 minutes) and 50 mL (range, 30-100 mL), respectively. One patient had intraoperative complication, showing broken ends ischemia of sigmoid colon after dragging out resected rectum from the anus, following free splenic flexure of colon, about 5 cm ischemic sigmoid colon were resected, and descending colonrectum anastomosis was performed. Time for outofbed activity and time for liquid diet intake were 1 days (range, 1-3 days) and 2 days (range, 1-9 days), respectively. Among 3 patients with postoperative complications (Ⅱ stage of ClavienDindo), 2 with incomplete intestinal obstruction were improved by gastrointestinal decompression and total parenteral nutrition, and 1 with presacral infection was improved by drainage and antibiotic therapy. Duration of postoperative hospital stay was 7 days (range, 5-21 days). (2) Postoperative pathological situations: length of surgecal specimen, tumor diameter and distance from tumor to resected distant intestinal canal were respectively 18.0 cm (range, 12.0-24.0 cm), 3.5 cm (range, 0.5-6.8 cm) and 2.5 cm (range, 1.0-5.0 cm). Evaluation of mesorectum of surgical specimen: 14 patients had complete mesorectum of surgical specimen and 2 had nearly complete mesorectum. There was no residual tumor at circumferential resection margin,proximal and distal ends. Pathological T stage of 16 patients: T0 (pathological complete response after neoadjuvant therapy), T1, T2 and T3 stages were found in 1, 1, 4 and 10 patients, respectively. Pathological N stage: 12, 2 and 2 patients were detected in N0, N1 and N2 stages, respectively. Number of lymph node detected was 16 (range, 6-32). Tumor cell differentiation: no tumor cell (pathological complete response after neoadjuvant therapy), high, moderate and lowdifferentiated tumors were respectively detected in 1, 2, 7 and 6 patients. (3) Followup. All the patients were followed up for 12 months (range, 4-16 months). There were no local tumor recurrence or distant metastasis and death.
Conclusion:LaTaTME may be a new, safe and effective resection for middlelow rectal cancer.