New Approach for the Resection of Low Rectal Cancer

A novel approach to single-incision laparoscopic surgery (SILS) could be used as an effective tool for resection of low rectal cancer.

Researchers at Nanjing University (China) developed a hybrid surgical approach for rectal cancer resection, which was applied in 20 patients with biopsy-proven malignant lesions who were also required to undergo abdominal computed tomography (CT) examination for determining tumor stage, and digital rectal examination on the surgery day. The surgical procedure involved cylindrical abdomino-perineal resection with the patients in the prone jackknife position to achieve peritoneal reflection, followed by SILS performed in the supine position using a homemade single-port device.

The results showed that the average distance from the anal verge was 2.6 cm and the mean tumor diameter confirmed by pathology was 3 cm, with the circumferential margin negative in all the specimens. The mean fabrication and set-up time of the homemade SILS device was 7.75 minutes, and the average operating time was 139 minutes with minimal blood loss; there were no conversions from SILS to conventional laparoscopy. The researchers found that on average, oral intake can often be successfully initiated 7.35 hours after surgery, with the first passage of flatus from the colostomy occurring two and a half days postoperation. During the 6-month-long follow-up stage, no morbidity or mortality was observed, except two patients that experienced poor union in perineum incision. The study was published in the December 2012 issue of Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.

“Cylindrical abdominoperineal resection combined with SILS is a feasible alternative for low rectal cancer, providing benefits like leaving enough exposure for operation, reducing trauma to surrounding organs, almost completely avoiding circumferential involvement, and allowing fast postoperative recovery,” concluded lead author Pan Hua-Feng, MSc.

Low rectal cancer is defined as located within 6 cm of the anal verge, and it requires careful consideration due to the low position in the body. Low rectal cancer means that the anastomotic join is very low in the body and it carries a high risk of fecal incontinence, especially if there has been any neoadjuvant radiotherapy to assist in retaining the sphincters and allows patients to retain function. When this is not possible, an abdomino-perineal excision (APE) is used to remove the rectum, including the anus, requiring the patient have to have a permanent stoma.

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Nanjing University