Reconstructive techniques after rectal resection for rectal cancer

A Single Centre Retrospective Evaluation of Laparoscopic Rectal Resection with TME for Rectal Cancer: 5-Year Cancer-Specific Survival

Laparoscopic colon resection has established its role as a minimally invasive approach to colorectal diseases. Better long-term survival rate is suggested to be achievable with this approach in colon cancer patients, whereas some doubts were raised about its safety in rectal cancer. Here we report on our single centre experience of rectal laparoscopic resections for cancer focusing on short- and long-term oncological outcomes. In the last 13 years, 248 patients underwent minimally invasive approach for rectal cancer at our centre. We focused on 99 stage I, II, and III patients with a minimum follow-up period of 5 years. Of them 43 had a middle and 56 lower rectal tumor. Laparoscopic anterior rectal resection was performed in 71 patients whereas laparoscopic abdomino-perineal resection in 28. The overall mortality rate was 1%; the overall morbidity rate was 29%. The 5-year disease-free survival rate was 69.7%, The 5-year overall survival rate was 78.8%.

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

BACKGROUND

The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline.

METHODS

An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference.

RESULTS

Laparoscopic surgery for extraperitoneal (mid- and low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open in terms of disease-free survival, overall survival or local recurrence. Laparoscopic pelvic dissection may impair genitourinary and sexual function after rectal resection, like in open surgery.

CONCLUSIONS

Laparoscopic surgery for mid- and low-rectal cancer can be recommended under optimal conditions. Still, most level 1 evidence is for colon cancer surgery rather than rectal cancer. Upcoming results from large randomised trials are awaited to strengthen the evidence for improved short-term results and equal long-term results in comparison with the open approach.

Low anterior resection: alternative anastomotic techniques

Low anterior resection (LAR), with its numerous technical modifications, is one of the most commonly performed operations for rectal cancer. In the past, patients with locally advanced distal rectal cancer were most frequently treated by abdominoperineal resection and permanent colostomy. However, over the past two decades and with improved understanding of tumor biology and refinement in technique, use of LAR to treat rectal cancer has increased substantially. Yet, despite the significant increase in LAR and sphincter preservation, patients in many areas of the country have little access to these techniques and continue to commonly be treated with abdominoperineal resection. This article examines the surgeon's unique and critical role in the pretreatment evaluation and decisions leading to choice of surgical therapy for locally invasive distal rectal cancer. In particular, the authors focus on technical aspects to preserve the anal sphincter, and review methods to optimize functional outcomes in the setting of low pelvic anastomosis.

Ressecção anterior ultrabaixa e interesfinctérica do reto com anastomose coloanal por videolaparoscopia

O autor apresenta, detalhadamente, a técnica de ressecção anterior ultrabaixa e interesfinctérica com anastomose coloanal por videolaparoscopia para tratamento do câncer do reto distal. São descritos os principais passos da operação: 1 - Posição do Paciente; 2 - Posicionamento do Equipamento e Equipe; 3 - Posicionamento dos Trocartes e Exploração da Cavidade Abdominal; 4 - Exposição do Campo Operatório; 5 - Ligadura dos Vasos Mesentéricos Inferiores pelo acesso medial; 6 - Mobilização do Ângulo Esplênico e do Colon Sigmóide; 7 - Excisão total do mesorreto, preservação dos nervos pélvicos e mobilização do reto pela técnica de Rullier; 8- Secção do reto distal e anastomose coloanal;9-Ressecção interesfinctérica (RI) e anastomose coloanal com coloplastia transversa, bolsa colónica em J ou anastomose latero-terminal. A utilização desta técnica, apesar de ser um procedimento complexo, mostrou-se viável e segura, pois apresentou baixo índice de complicação pós-operatória e mortalidade.

Retrograde colonic irrigation for faecal incontinence after low anterior resection

BACKGROUND AND AIMS

This study aims to evaluate the therapeutic effect of retrograde colonic irrigation in patients with faecal incontinence after a low anterior resection for a rectal carcinoma.

MATERIALS AND METHODS

Patients with a previous low anterior resection, who were selected for treatment with retrograde colonic irrigation for faecal incontinence between 2005 and 2008, were included in the study. The data from the patients were gathered by chart research and an interview by phone.

RESULTS

Thirty patients were included in the study. Three patients died and one patient was not able to answer questions due to a cognitive disorder. The data of the remaining 26 patients were analysed. Five patients had already stopped with the retrograde colonic irrigation treatment due to side effects. Twelve of the 21 patients (57.46%) who still performed RCI became completely (pseudo)continent, three patients (14.2%) were incontinent for flatus and six patients (29.4%) were still incontinent for liquid stool. Five patients stopped with the retrograde colonic irrigation treatment due to side-effects.

CONCLUSION

Retrograde colonic irrigation is an effective method to treat patients with faecal incontinence after a low anterior resection for rectal carcinoma. Retrograde colonic irrigation is not invasive and has only mild side effects.