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Langenbeck's Archives of Surgery

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01-03-2020 | Rectal Cancer | How-I-Do-It articles

Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer

Authors: Liang Bi, Xiangbing Deng, Xia Meng, Xuyang Yang, Mingtian Wei, Qingbin Wu, Minyang Ren, Ziqiang Wang

Published in: Langenbeck's Archives of Surgery | Issue 2/2020

Abstract

Purpose

Proper transection of the distal rectum is important for reconstruction of bowel continuity in rectal cancer surgery. In this study, we introduced a modified technique for ligation of the distal rectum, and investigated its safety and efficiency to facilitate the rectum transection.

Methods

After complete mobilization and transection of the mesorectum, a cable tie was carefully positioned distal to the tumor, followed by washout and transecting the rectum with a linear stapler. From September 2017 to June 2018, consecutive 67 mid-low rectal cancer patients with laparoscopic anterior resection underwent this technique. Clinical data of these patients, including number of firings, pathological and operative variables, and postoperative outcomes, were compared with those of 132 consecutive patients who underwent traditional surgery from January 2016 to August 2017.

Results

Compared with the traditional method, cable tie ligation significantly reduced the number of firings (1.1 ± 0.32 vs. 1.3 ± 0.52, p < 0.001). A very high ratio of one firing transection of rectum was observed in the cable tie group (94.0% vs. 68.9%, p < 0.001), even in patients with tumor at or below the peritoneal reflection (90.2% vs. 54.4%, p < 0.001), in male patients (95.5% vs. 65.8%, p < 0.001), and in obese patients (93.8% vs. 64.9%, p = 0.005). The mean distal margin was longer in the cable tie group (3.19 ± 1.77 cm vs. 2.54 ± 1.36 cm, p = 0.005), with no positive distal margin observed. The operation time, quality of mesorectum, and morbidity between two groups were comparable. Two leaks (3.0%) in the cable tie group were observed, similar to 3.8% in the control.

Conclusions

Ligation of the rectum with a cable tie reduces the number of cartridges, and increases the rate of one stapler firing for rectal transection, even in those difficult cases like male, overweight, and low rectal cancer patients. It is also useful for occlusion of the rectum before washout. It is safe, feasible, and worthwhile for popularization.

Trial registration

Registered at ClinicalTrial.gov, number NCT03570684

Available only for authorised users

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Title: Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer
Authors: Liang Bi
Xiangbing Deng
Xia Meng
Xuyang Yang
Mingtian Wei
Qingbin Wu
Minyang Ren
Ziqiang Wang
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Keywords: Rectal Cancer
Rectal Cancer
Published in: Langenbeck's Archives of Surgery / Issue 2/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01863-6

At a glance: The STEP trials

Springer Medicine

Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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