Experience of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer

Objective To investigate the advantages and disadvantages of transanal total mesorectal excision with laparoscopic assisted for min-low rectal cancer. Methods Retrospectively analyzed the clinical data of 38 patients with min-low rectal cancer who undernent laparoscopically assisted transanal total anorectal rectal cancer from November 2014 to May 2018 in the Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The main outcome measures included gender, BMI, the operating time, intra-operative blood loss, the intra- and post-operative complication rate, the distal resection margin length and the circumferential resection margin status of the pathological specimen, the number of lymph nodes acquisitions, as well as the postoperative average hospitalization time. Results The surgery was completed smoothly for all patients in this studying, with no conversion to open surgery. Among all the 38 patients, there were 26 (68.4%) male cases and 12(31.6%) female cases, and 25 cases were with a body mass index (BMI) over 24 kg/m2. The average operating time was (175.2±37.6) minutes. The average intra-operative blood loss was (63.9±42.7) ml. The complications included 1 case of intra-operative presacral venous hemorrhage, and 6 cases of post-operative anastomotic leak (15.8%). There were 18 cases happened perioperative complications, and the rate was 47.4%. The average distance from the distal resection margin to the lower end of the tumor was (2.1±0.4) cm. There were 34 cases of complete mesorectal excision. The average number of lymph nodes retrieved was 14.2±4.5. The average postoperative hospital stay was (9.8±5.9) days. Conclusion Transanal total mesorectal excisionwithlaparoscopic-assisted formid-lowrectal cancer can more accurately ensure adequate distal margin and mesorectal integrity. Key words: Rectal neoplasms; Surgical procedures, minimally invasive; Laparoscopes; Transanal total mesorectal excision