Kentaro Sato, Hajime Morohashi, Yoshiyuki Sakamoto, Takuya Miura, Tatsuya Yoshida, Takahiro Suzuki, Kenichi Hakamada. Department of Gastroenterological Surgery, Hirosaki University
Introduction: The results of the Japan Clinical Oncology Group (JCOG) 0212 Study suggested that total mesorectal excision (TME) and lateral lymph node dissection (LLND) could become the standard treatment for lower rectal carcinoma. However, LLND must also be performed laparoscopically if surgery for lower rectal carcinoma is to be carried out as a completely laparoscopic procedure. Transanal TME (TaTME) is expected to provide better results than the conventional TME, both oncologically and in terms of pelvic function, and its use has recently been spreading in Japan. We started performing laparoscopic TaTME + LLND in our department in July 2016 and here report the short-term outcomes.
Subjects and Methods: We used laparoscopic TaTME + LLND to treat 5 men and 3 women with cT3 or deeper rectal carcinoma in whom the inferior margin of the tumor was on the anal side of the peritoneal reflection. This was a retrospective study of short-term postoperative outcomes.
Surgical Procedure: Laparoscopic surgery was started simultaneously by two teams, one working transabdominally and the other working transanally. The transabdominal team performed the standard proximal LLND and mobilization of the splenic flexure via five ports. They then dissected the bilateral lateral lymph nodes, mainly in the obturator (#283) and internal iliac (#263) groups. During this time, the transanal team performed laparoscopic TaTME. Finally, both dissection layers were connected and the cancer was excised.
Results: Six patients had clinical stage II and two had clinical stage III lower rectal carcinoma. All the patients underwent preoperative chemotherapy with S-1 + L-OHP. Five underwent a sphincter-preserving surgery, and three underwent rectal amputation. The mean operating time was 335 minutes (range, 267–382 minutes), and the mean amount of hemorrhage was 136 g (20–440 g). The mean number of lymph nodes dissected was 24, and R0 resection was performed in all the cases. The mean length of hospital stay was 14 days, and a postoperative complication of Clavien-Dindo grade III or higher occurred in one patient (anastomotic failure).
Conclusions: Laparoscopic TaTME + LLND performed by two teams simultaneously is an extremely useful procedure that not only reduces operating time, but also is less invasive than laparoscopic surgery. It may also be effective for improving curative nature, nerve preservation, and anal function.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86960
Program Number: P225
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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