Takeshi Hagihara, MD, Akiyoshi Kanazawa, PhD, Hideyuki Masui, MD, Meiki Fukuda, MD, Yukihiro Kono, PhD
Osaka Red Cross Hospital
INTRODUCTION: The spread of endoscope surgery for the colon cancer operation is remarkable, but a clinical trial is going in the endoscope surgery for rectal cancer, and do not yet lead to a standard surgical procedure. Laparoscopic approach for rectal cancer has good operative view that has obvious advantage for improvement of operative procedure and education. A correct surgical procedure to rectal cancer has to make due allowance for both improved overall survival with local control of disease and preservation of the sphincter and urinary functions. We tried the standardization of laparoscopic rectal surgery and consider that the process should reduce the complication rate. In this paper, we focused on the short-term results of recent laparoscopic rectal surgery for lower rectal cancer.
METHODS: We routinely performed autonomic nerve-sparing TME with left colic artery preserving for good blood supply of anastomosis in LAR cases. For the reproducible operation, the important points are as follows: 1) symmetrical five-port system 2) making premeditated operative field with same instruments and same view angle, 3) precise role of assistant, 4) enough rectal mobilization of rectum for cutting distal side of tumor.
RESULTS: Between April. 2009 and March 2012, 113 cases of laparoscopic low resection (LAR) performed in our hospital. The mean time operating time of LAR was 219 ± 53.5 min. The mean numbers of lymphadenectomy was 14.9 ± 7.9. Thirteen patients (11.5%) sustained complications: SSI (n=4), anastomotic stricture (n=4), dyschezia (n=3), hernia (n=1), small-bowel obstruction (n=1). There was no anastomotic leakage in LAR case.
CONCLUSION: Standardized laparoscopic TME technique is feasible and safe. We suggest that with the development of improved technic devices and more experience, laparoscopic resection for rectal cancer should be the standard method.
Session: Poster Presentation
Program Number: P117