Transperineal abdominoperineal resection synchronously assisted by laparoscopic approach for low rectal cancer directly invading the posterior wall of the vagina

Excerpt

Abdominoperineal resection (APR) has been the gold standard surgical treatment for patients with advanced low rectal cancer, but the procedure has not improved patients’ oncological outcome compared with those who undergo low anterior resection [1]. This relatively poor prognosis of APR is mainly due to the high rates of a positive circumferential resection margin (CRM) [2]. In cases of APR with positive resection margins, 57% of cases were reported to be located anteriorly [3]. It is still an anatomical challenge to obtain CRM for an anterior advanced rectal cancer, especially for T4 cancer. Recently, the efficiency of transanal endoscopic surgery, including transanal total mesorectal excision (TME), in rectal cancer surgery has been demonstrated [4, 5]. The technical advantages and better visualization that this approach affords may further facilitate better outcomes for patients with locally advanced rectal cancer. …