Takuya Yamaguchi, MD, K Toguchi, K Toyama. MImihara Genaral Hospital
Introduction and purpose)
Locally advanced lower rectal cancer in female sometimes invades vaginal posterior wall.
Posterior pelvic exenteration is the standard
procedure performed for patients with this type of rectal
cancer. Posterior pelvic exenteration involving en bloc
removal of the rectum and reproductive organs may be performed with curative intent, with negative surgical margins. However,
these patients require a permanent fecal stoma.
Recent advances in laparoscopic inter sphincteric resection(ISR) for lower rectal cancer have allowed colo-anal anastomoses to be performed without adversely affecting outcome.
We evaluated the feasibility of laparoscopic ISR with hysterectomy for lower rectal cancer invading with vaginal wall.
At the first part, laparoscopic vaginal-hysterectomy was performed. After confirming that these were no severe adhesions or obvious tumor involvement to the pelvic side wall, the left colon was mobilized and the inferior mesenteric artery was transected. The posterior sides of the rectum were mobilized down to the pelvic floor without lateral lymph node dissection.
The pelvic nerve plexus were not sacrificed.
The ureters were visualized and carefully protected
throughout the procedure. Both side of vaginal lateral walls are divided using bipolar sealing device to mobilize rectum.
After that, using the peranal approach for intersphincteric resection (ISR),
We performed en bloc removal of the rectum with posterior vaginal wall. A colo-anal anastomosis was established. Finally, the diverting stoma was created ,which was closed 3 months after radical surgery.
Conclusion) Laparoscopic ISR after laparoscopic hysterectomy might be feasible for selected patients with advanced rectal cancer involving posterior vaginal wall.
Program Number: P118