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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2016

01-11-2016 | Colorectal Cancer

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

Authors: Akiyo Matsumoto, MD, Kaida Arita, MD

Published in: Annals of Surgical Oncology | Issue 12/2016

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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.
Appendix
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Literature
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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.CrossRefPubMed
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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.CrossRefPubMed
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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.CrossRefPubMed
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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.CrossRefPubMed
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Parfitt JR, Driman DK. The total mesorectal excision for rectal cancer: a review of its pathological assessment. J Clin Pathol. 2007;60:849–55.CrossRefPubMed
Metadata
Title
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
Authors
Akiyo Matsumoto, MD
Kaida Arita, MD
Publication date
01-11-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5442-6

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