Loosening and lengthening of intestinal tract after rectal isolation in anus-saving resection for rectal carcinoma

Abstract

In low rectal cancer surgery, the section of rectum destal to the lower tumor margin is relaxed and lengthened after fully isolation of the organ. This would facilitate the adoption of anus saving operation. Before and after fully isolation of the rectum in low rectal cancer surgery, the distance between the lower tumor margin and the anorectal line was measured by the same rectuscope introduced through the anus. The two results were compared. The average lengthening was less than 1 cm if the lower tumor margin - anorectal line distance was 5 cm. It was 1–2 cm if the lower tumor margin - anorectal distance was 6 cm. It was more titan 2 cm if the distance was 7–9 cm. The loosening and lengthening of the rectal canal was related to the presence of lymphnode metastasis and the skill of the operator. The lengthening was also influenced by the body build of the patient, involvement of the rectal circumference and the Dukes stage. Modified Park’s operation, trans - abdominosacral resection with anastomosis of rectum, and anterior resection on transpubic approach are indicated for those in whom the lower tumor margin -anorectal line distance was 5 cm. The rectectomy - anastomosis in the abdominal cavity (Dixon’s operation) is indicated for those in whom the lower tumor margin- anorectal line was 6 cm. If manual anastomosis is difficult, stapling device may be used. The anus saving resection is easy if the distance was 7–9 cm.