Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer

被引:161
|
作者
Rullier, E [1 ]
Sa Cunha, A
Couderc, P
Rullier, A
Gontier, R
Saric, J
机构
[1] Hop St Andre, Serv Chirurg Digest, Dept Surg, F-33075 Bordeaux, France
[2] Pellegrin Hosp, Dept Pathol, Bordeaux, France
关键词
D O I
10.1002/bjs.4052
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The feasibility of laparoscopic rectal resection in patients with mid or low rectal cancer was studied prospectively with regard to quality of mesorectal excision, autonomic pelvic nerve preservation and anal sphincter preservation. Methods: Laparoscopic rectal excision was performed in 32 patients (21 men) with rectal carcinoma located 5 cm from the anal verge. Most patients had T3 disease and received preoperative radiotherapy. The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, intersphincteric resection, transanal coloanal anastomosis with coloplasty and loop ileostomy. Results: Three patients needed conversion to a laparotomy. Postoperative morbidity occurred in ten patients, related mainly to coloplasty. Macroscopic evaluation showed an intact mesorectal excision in 29 of 32 excised specimens; microscopically, 30 of the 32 resections were R0. Sphincter preservation was achieved in 31 patients. The hypogastric nerves and pelvic plexuses were identified and preserved in 24 of the 32 patients. Sexual function was preserved in ten of 18 evaluable men. Conclusion: A laparoscopic approach can be considered in most patients with mid or low rectal cancer.
引用
收藏
页码:445 / 451
页数:7
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