Abstract
Background
The gold standard of rectal surgery is TME and DST anastomosis.1 – 6 The division of mesorectum in tumor-specific mesorectal and total mesorectal excisions is one of the most difficult procedures of anterior dissection. We have developed a laparoscopic-assisted anterior dissection technique using the simple Rectum Catcher device (RC) with an intraoperative colonoscopy (CF).7 , 8
Methods
Surgical and oncological outcomes were compared between 99 patients undergoing a laparoscopic approach with the RC and a CF (RCF) and 104 patients undergoing the laparoscopic approach without the RC and without a CF (NRCF). Our standardized procedure for RCF is shown in the video.
Results
BMI (p = .025) and tumor diameter (p = .002) were significantly higher in the RCF group. However, operation times (p = .005) and time to tolerate diet (p = .009) were significantly shorter. Estimated blood loss was significantly decreased (p = .005) and quality of TME or TSME was significantly better (p = .017) in the RCF group. When we further analyzed surgical and oncological outcomes by dividing 3 parts of the rectum, patients with rectosigmoid (Rs) cancer and patients with cancer in the rectum below the peritoneal reflection (Rb) had comparable results. Particularly, statistically significant differences in length of operation time (p = .018), estimated blood loss (p = .050), quality of TME or TSME (p = .017), time to tolerate diet (p = .010), and R0 resections (p = .050) were observed in the patients with cancer below the peritoneal reflection.
Conclusions
Laparoscopic lower rectal surgery using the RC with a CF is feasible and provides acceptable surgical and oncological outcomes.
Similar content being viewed by others
References
Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence. Br J Surg. 1982;69:613–6.
Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson JR. Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum. 2001;44:315–21.
Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jamieson C. Double stapling technique for low anterior resection. Dis Colon Rectum. 1983;26:231–5.
Feinberg SM, Parker F, Cohen Z. The double stapling technique for low anterior resection of rectal carcinoma. Dis Colon Rectum. 1986;29:885–90.
Griffen FD, Knight CD, Whitaker JM, Knight CD Jr. The double stapling technique for low anterior resection. Ann Surg. 1990;211:745–51.
Plasencia G, Jacobs M, Verdeja JC, Viamonte M 3rd. Laparoscopic-assisted sigmoid colectomy and low anterior resection. Dis Colon Rectum. 1993;37:829–33.
Matsumoto A, Arita K, Tashiro M, Haruki S, Usui S, Hiranuma S. The simple Rectum Catcher device is useful tool for laparoscopic-assisted high and lower rectal surgery. Surg Endosc. 2008;22:1905–9.
Matsumoto A, Arita K, Tashiro M, Haruki S, Usui S, Hiranuma S. Laparoscopic-assisted low and ultralow anterior resection for lower rectal cancer using the simple Rectum Catcher device and an intra-operative colonoscopy. Int J Colorectal Dis. 2012;27:243–7.
Parfitt JR, Driman DK. The total mesorectal excision for rectal cancer: a review of its pathological assessment. J Clin Pathol. 2007;60:849–55.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MP4 85649 kb)
Supplementary material 2 (MP4 167634 kb)
Supplementary material 3 (MP4 90629 kb)
Rights and permissions
About this article
Cite this article
Matsumoto, A., Arita, K. Laparoscopic-Assisted Rectal Surgery for Rectal Cancer Using the Simple Rectum Catcher Device with an Intraoperative Colonoscopy: Results of Our Hospital Study in 203 Patients. Ann Surg Oncol 23, 3941–3947 (2016). https://doi.org/10.1245/s10434-016-5442-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-016-5442-6