Akiyo Matsumoto, MD, Kaida Arita, MD. Tsuchiura Kyodo General Hospital
Background: The gold standard of rectal surgery is TME and DST anastomosis. The division of mesorectum in tumor specific mesorectal and total mesorectal excisions is one of the most difficult procedures of anterior dissection. We have developed a laparoscopic assisted anterior dissection technique using the simple Rectum Catcher device (RC) with an intra-operative colonoscopy (CF).
Methods: Surgical and oncological outcomes were compared between 99 patients undergoing a laparoscopic approach with the RC and a CF (RCF) and 104 patients undergoing the laparoscopic approach without the RC and without a CF (NRCF).
Our standardized procedure for RCF is shown in the video.
Results: BMI (p=0.025) and tumor diameter (p=0.002) were significantly higher in the RCF group. However, operation times (p=0.005) and time to tolerate diet (p=0.009) were significantly shorter. Estimated blood loss was significantly decreased (P=0.005) and quality of TME or TSME was significantly better (p=0.017) in the RCF group.
When we further analyzed surgical and oncological outcomes by dividing three parts of the rectum, patients with recto-sigmoid (Rs) cancer and patients with cancer in the rectum below the peritoneal reflection (Rb) had comparable results. Particularly, statistically significant differences in length of operation time (p=0.018), estimated blood loss (p=0.050), quality of TME or TSME (p=0.017), time to tolerate diet (p=0.010) and R0 resections (p=0.050) were observed in the patients with cancer below the peritoneal reflection.
Conclusions: Laparoscopic lower rectal surgery using the RC with a CF is feasible and provides acceptable surgical and oncological outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77881
Program Number: V032
Presentation Session: Thursday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo