2019, Number 2
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Revista Cubana de Cirugía 2019; 58 (2)
Laparoscopic ultralow anterior rectal resection with coloanal anastomosis in low rectum cancer
Barreras GJE, Pereira FJG, Llorente LF, Martínez AMÁ, Torres PR
Language: Spanish
References: 36
Page: 1-16
PDF size: 430.68 Kb.
ABSTRACT
Introduction: Laparoscopic ultralow anterior rectal resection with coloanal anastomosis prevents the performance of a definitive colostomy.
Objective: To determine the indications, describe the surgical technique and show the long-term outcome of performing this procedure in the treatment of cancer of the lower rectum.
Method: A descriptive and prospective observational study of 53 patients with low rectal cancer was carried out in the period between October 2007 and November 2018, at the National Center for Minimum Access Surgery. All resections were carried out by a group dedicated to colorectal surgery. In all cases, the total mesorectal excision was performed.
Results: 53 patients (30 males and 23 females), with an average age of 57 years (range 23-81) and 42 (79.2%) after neoadjuvant therapy were operated using this technique. The average surgical time was 195 min (range 90-360) and the estimated blood loss was 72 mL. The incidence of major morbidity was 16.9% (9/53) and the average hospital stay was 6.3 days. The mean follow-up period was 40 months (range 1-132), with a local relapse of 9.4% (5/53) and a 5-year overall survival of 80.3%.
Conclusions: Laparoscopic ultralow anterior resection of the rectum with coloanal anastomosis is a safe technique with excellent outcomes in terms of local relapse and overall survival.
REFERENCES
Glimelius B, Tiret E, Cervantes A, Arnold D. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi81-8. Disponible en: http://annonc.oxfordjournals.org/content/24/suppl_6/vi81.full.pdf+html
Barreras González JE, Barreras Sepúlveda EJ, Cáceres Lavernia HH. De la resección abdominoperineal a las técnicas conservadoras de esfínteres en la cirugía laparoscópica del cáncer del recto. Rev Cubana Cir. 2017;56(1).
Parks AG. Transanal technique in low rectal anastomosis. Proc R Soc Med. 1972;65:975.
Heald RJ. A new approach to rectal cancer. Br J Hosp Med. 1979;22(3):277-81.
Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomized controlled trial. Lancet Oncol. 2010;11:637-45.
Van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Colorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210-8.
Golligher J. Cirugía del ano, recto y colon. 5ta ed. Barcelona: Mason Salvat; 2007. p. 574-9.
Goldberg SM, Gordon PH H, Nivatvongs S. Fundamentos de Cirugía Anorrectal. México, D F. 1992. p. 233-68.
Klingensmith ME, Chen LE, Glasgow SC, Goers TA, Melby SJ. The Washington Manual of Surgery. 5th ed. Washington: Lippincott Williams & Wilkins; 215-37.
Bullard Dunn KM, Rothenberger DA. Colon, recto y ano. En: Brunicardi FC. Schwartz’s Principios de Cirugía. Décima edición. Estados Unidos de América: Editorial McGraw-Hill; 2015.
Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand HS, et al. A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Adjuvant Breast Can Bowel Protocol R-03. Dis Colon Rectum. 2004;40(2):131-9.
Swedish Rectal Cancer Trial. Improved survival with preoperative radiotherapy in resectable rectal cáncer. N Engl J Med. 1997;336:980-7.
Wibe AA, Syse A, Andersen E, Tretli H, Myrvold H, Soreide O, on behalf of the Norwegian Rectal Cancer Group. Oncologic outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior versus abdominoperineal resection. Dis Colon Rectum. 2004;47(1):48-58.
Kapiteijn E, Maeijnen C, Nagtegaal I, Putter H, Steup W, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cáncer. For the Dutch Colorectal Cancer Group. N Engl J Med. 2001;345:638-64.
Rullier E, Denost Q, Vendrely V, Rullier A, Laurent C. Low rectal cancer: Classification and standardization of surgery. Dis Colon Rectum. 2013;56:560-7.
Marks GJ, Marks JH, Mohiuddin M, Brady L. Radical sphincter-preservation surgery with coloanal anastomosis following high-dose external irradiation for the very low lying rectal cáncer. Recent Results Cancer Res. 1998;146:161-74.
Guillem J, Chessin DB, Shia J, Suriawinata A, Riedel E, Moore HG, et al. A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy. Implications for sphincter preservation. Ann Surg. 2007 Jan;245:88-93.
Schiessel R, Karner-hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376-8.
Marks J, Mizrahi B, Dalane S, Nweze I. Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc. 2010; 24:2700-7. DOI 10.1007/s00464-010-1028-8.
Marks G, Mohiuddin M, Rakinic J. New hope and promise for sphincter preservation in the management of cancer of the rectum. Semin Oncol. 1991;18:388-98.
Li SY, Chen G, Du JF, Chen G, Wei XJ, Cui W, et al. Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions. World J Gastroenterol. 2015;21(16):4969-74.
Marks JH, Montenegro GA, Salem JF, Shields MV, Marks GJ. Transanal TATA/TME: a case-matched study of taTME versus laparoscopic TME surgery for rectal cancer. Tech Coloproctol. 2016; 20:467-73. DOI 10.1007/s10151-016-1482-y.
Williams NS, Murphy J. The APPEAR technique: a new concept in ultralow sphincter-saving resection. Dis Colon Rectum. 2008;51:369-70; author reply 371 [PMID: 18213492 DOI: 10.1007/ s10350-007-9156-5]
Di Palo S, De Nardi P, Chiari D, Gazzetta P, Staudacher C. Laparoscopic TME with APPEAR (Anterior and Perineal PlanE for ultra-low Anterior Resection of the Rectum) technique for distal rectal cancer. Surg Endosc. 2013;27:3430 [PMID: 23479252 DOI: 10.1007/s00464-013-2886-7]
Qiu HZ, Xiao Y, Lin GL, Wu B, Niu BZ, Zhou JL. Clinical application of anterior perineal plane for ultra-low anterior resection of the rectum. Zhonghua Weichang Waike Zazhi. 2012;15 47-50 [PMID: 22287351]
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13.
Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intesphincteric resection for low rectal cancer. Br J Surg. 2012;99:603-12.
Rullier E, Zerbib F, Laurent C. Intersphincteric resection with excision of the internal anal sphincter for conservative treatment for very low rectal cancer. Dis Colon Rectum. 1999;44:1168-75.
Tilney HS, Tekkis PP. Extending the horizons of restorative rectal surgery: interesphincteric for low rectal cancer. Colorectal Dis. 2008;10(1):3-15.
Tokoro T, Okuno K, Hida J, Ueda K, Yoshifujiet T, Daito K, et al. Analysis of the clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Word J Surg Oncol. 2013;11:24.
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology. 2018. Disponible en: www.nccn.org. Actualizado: 12/2018.
Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Gohl J. The influence of abdominoperanal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis. 2006;8:23-33.
Akasu T, Takawa M, Yamamoto S, Ishiguro S, Yamaguchi T, Fujita S, et al. Intersphincteric resection for very low rectal adenocarcinoma; univariate and multivariate analyses of risk factors for recurrence. Ann Surg Oncol. 2008;15:2668-76.
Tsukamoto SH, Kanemitsu Y, Shida D, Ochiai H, Mazaki J. Comparison of the clinical results of abdominoperanal intersphincteric resection and abdominoperineal resection for lower rectal cancer. Int J Colorectal Dis. 2017;32:683-9. DOI 10.1007/s00384-017-2755-2.
Pavlidis Th E, Pavlidis ET, Sakantamis AK. The Role of Intersphincteric Resection in Very Low Rectal Cancer. Ann Surg Oncol. 2017. DOI 10.1245/s10434-017-6150-6.
Dimitriou N, Michail O, Moris D, Griniatsos J. Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes. World J Gastrointest Oncol. 2015;7(7):55-70.