Abstract
Background
There are sporadic reports, with different verdicts, of restorative proctectomy by laparoscopic transanal pull-through (LTPT) without the use of a minilaparotomy for a part of the procedure. This study aimed to explore the applicability and advantages of LTPT with colon pouch–anal anastomosis for low rectal cancer, and to evaluate the results.
Methods
From January 2002 to July 2003, 10 of 12 patients (6 men and 4 women) undergoing a laparoscopic procedure for low rectal cancer (<6 cm from the anal verge) underwent LTPT. The mean age of these patients was 58 years. The results have been compared with those for 12 similar non–pull-through procedures performed during the same period.
Results
There was no operative mortality. An anastomotic leakage and a hemorrhagic gastropathy occurred in the LTPT group. During a mean follow-up period of 18 months (range, 12–26 months), there was no local relapse. Four patients manifested moderate incontinence. No significant differences in functional outcome were observed between the LTPT and control groups.
Conclusion
The authors’ experience supports use of the LTPT procedure with colonic pouch–anal anastomosis for selected lower rectal cancers with indications for a laparoscopic approach as an appropriate and reproducible surgical treatment.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bacon HE (1945) Evolution of sphincter muscle preservation and reestablishment of continuity in the operative treatment of rectal and sigmoidal cancer. Surg Gynecol Obstet 81: 113–127
Braun J, Treutner KH, Winkeltau G, Heidenreich U, Lerch MM, Schumpelick V (1992) Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma. Am J Surg 163: 407–412
Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SH (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230: 544–554
Gamagami R, Istvan G, Cabarrot P, Liagre A, Chiotasso P, Lazorthes F (2000) Fecal continence following partial resection of the anal canal in distal rectal cancer: long-term results after coloanal anastomoses. Surgery 127: 291–295
Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224: 58–65
Hartley JE, Mehigan BJ, Qureshi AE, Duthie GS, Lee PW, Monson (2001) Total mesorectal excision: assessment of the laparoscopic approach. Dis Colon Rectum 44: 315–321
Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL (2002) Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg 236: 49–55
Kirwan WO, Turnbull RB Jr, Fazio VW, Weakley FL (1978) Pull-through operation with delayed anastomosis for rectal cancer. Br J Surg 65: 695–698
Kockerling F, Reymond MA, Schneider C, Wittekind C, Scheidbach H, Konradt J, Kohler L, Barlehner E, Kuthe A, Bruch HP, Hohenberger W (1998) Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. The Laparoscopic Colorectal Surgery Study Group. Dis Colon Rectum 41: 963–970
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomised trial. Lancet 359: 2224–2229
Lazorthes F, Chiotasso P, Gamagami RA, Istvan G, Chevreau P (1997) Late clinical outcome in a randomized prospective comparison of colonic J pouch and straight coloanal anastomosis.Br J Surg 84:1449–1451
Maxwell-Armstrong CA, Robinson MH, Scolefield JH (2000) Laparoscopic colorectal cancer surgery. Am J Surg 179: 500–507
Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237: 335–342
Prete F, Liguori P, Nitti P, Vincenti L, Prete FP (2000) Optimal reconstruction after resection of the rectum in cancer surgery. Chir Ital 52: 323–328
Prete F, Sebastiani R, Sammarco DF, Prete FP (2001) Role of intersphincter resection among the surgical options for cancer of the distal rectum. Chir Ital 53: 765–772
Rullier E, Sa Cunha A, Couderc P, Rullier A, Gontier R, Saric J (2003) Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer. Br J Surg 90: 445–451
Sobin LH, Wittekind C (eds) (2002) TNM Classification of Malignant Tumours, 6th ed. John Wiley & Sons, Hoboken, New Jersey, USA
Tiret E, Poupardin B, McNamara D, Dehni N, Parc R (2003) Ultralow anterior resection with intersphincteric dissection: what is the limit of safe sphincter preservation? Colorectal Dis 5: 454–457
Watanabe M, Tatsuo T, Hasegawa H, Kitajima M (2000) Laparoscopic ultralow anteriore resection combined with per anum intersphinteric rectal dissection for lower rectal cancer. Dis Colon Rectum 43: S94–297
Weiser MR, Milsom JW (2000) Laparoscopic total mesorectal excision with autonomic nerve preservation. Semin Surg Oncol 19: 396–403
Williamson ME, Lewis WG, Finan PJ, Miller AS, Holdsworth PJ, Johnston D (1995) Recovery of physiologic and clinical function after low anterior resection of the rectum for carcinoma: myth or reality? Dis Colon Rectum 38: 411–418
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Prete, F., Prete, F.P., De Luca, R. et al. Restorative proctectomy with colon pouch–anal anastomosis by laparoscopic transanal pull-through: an available option for low rectal cancer?. Surg Endosc 21, 91–96 (2007). https://doi.org/10.1007/s00464-004-9263-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-9263-5