[Risk factors of coloanal anastomotic stricture after laparoscopic intersphincteric resection for low rectal cancer]

Treatment of rectal anastomotic atresia with transurethral prostate resection instrumentation: A report of three cases

Dixon surgery for rectal cancer can lead to severe intestinal narrowing and blockage that is difficult to treat with open surgery or colonoscopy. The aim of the present study was to develop a minimally invasive approach for treating rectal anastomotic atresia based on three cases that were managed with transurethral prostate resection instrumentation. Preoperative imaging determined the distance from the anastomotic closure to the anal margin, the length of the anastomotic closure and the degree of proximal intestinal dilation for all cases. During the procedure, the anastomotic site was visualized, and a circular electrode was used to excavate and open the blockage. Membrane-like closures were directly incised to achieve satisfactory results, with an anastomotic diameter >20 mm. Those cases with tubular atresia required an initial incision using the prostate resectoscope to relieve the obstruction, followed by radial incisions until achieving an anastomotic diameter >20 mm. At 3-6 months post-dilation, two of the patients with anastomotic atresia >20 mm had satisfactory bowel movements, whereas the remaining patient experienced tumor recurrence at the anastomotic site and discontinued treatment. This case series demonstrates the potential of transurethral prostate resection instrumentation as a safe and effective minimally invasive approach for rectal anastomotic atresia. Given that prostate resection instrumentation is readily available in hospitals in China, this approach is widely accessible to most patients. Furthermore, the technique leverages existing surgical technology and practices, requiring only a shift in the surgical site.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

Background

Intersphincteric resection (ISR) has been a preferable alternative to abdominoperineal resection (APR) for anal preservation in patients with low rectal cancer. Laparoscopic ISR and robotic ISR have been widely used with the proposal of 2 cm or even 1 cm rule of distal free margin and the development of minimally invasive technology. The aim of this review was to describe the newest advancements of ISR.

Methods

A comprehensive literature review was performed to identify studies on ISR techniques, preoperative chemoradiotherapy (PCRT), complications, oncological outcomes, and functional outcomes and thereby to summarize relevant information and controversies involved in ISR.

Results

Although PCRT is employed to avoid positive circumferential resection margin (CRM) and decrease local recurrence, it tends to engender damage of anorectal function and patients' quality of life (QoL). Common complications after ISR include anastomotic leakage (AL), anastomotic stricture (AS), urinary retention, fistula, pelvic sepsis, and prolapse. CRM involvement is the most important predictor for local recurrence. Preoperative assessment and particularly rectal endosonography are essential for selecting suitable patients. Anal dysfunction is associated with age, PCRT, location and growth of anastomotic stoma, tumour stage, and resection of internal sphincter.

Conclusions

The ISR technique seems feasible for selected patients with low rectal cancer. However, the postoperative QoL as a result of functional disorder should be fully discussed with patients before surgery.