1Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan 2Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Dis Colon Rectum. 2014 Jul;57(7):900-4. doi: 10.1097/DCR.0000000000000146.
Rectal GI stromal tumor is uncommon. Local excision with free resection margins provides adequate treatment, but extended surgery such as abdominoperineal resection has been frequently performed because of technical difficulties in the confined pelvic space.
We aimed to report the technical details of a new method of local excision for rectal GI stromal tumor: the modified laparoscopic intersphincteric resection technique.
This study was a retrospective analysis.
This study was performed at a single institute.
We included 3 patients with rectal GI stromal tumor who underwent this procedure following neoadjuvant imatinib therapy.
Medial-to-lateral retroperitoneal dissection was begun near the sacral promontory, and rectal dissection while preserving autonomic nerves was performed down to the pelvic floor into the anal canal without dividing the inferior mesenteric artery. Dissection between the tumor and prostate was meticulously performed under laparoscopic magnified view. Next, circumferential connection between the laparoscopic and transanal dissections was performed through a transanal approach, and the rectum was extracted through the anus. Circular full-thickness local excision of the rectum and handsewn straight rectoanal anastomosis was performed.
The safety and feasibility of this procedure were the primary outcomes measured by this study.
The median operative time was 180 minutes, and the median estimated blood loss was 115 mL. There were no conversions or intraoperative complications, and there was 1 postoperative intestinal obstruction that recovered with conservative therapy. All patients had negative resection margins (R0), including 1 pathological complete response.
The study was limited by the small number of patients.
This modified laparoscopic intersphincteric resection technique is a novel and safe method for local excision of rectal GI stromal tumors located very close to the anus (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A139).
直肠胃肠道间质瘤并不常见。游离切缘的局部切除可提供充分的治疗，但由于骨盆空间有限，技术难度较大，常需进行扩大手术，如腹会阴切除术。
我们旨在报告一种直肠胃肠道间质瘤局部切除的新技术方法：改良腹腔镜经括约肌间切除术。
本研究为回顾性分析。
本研究在一家医院进行。
我们纳入了 3 例接受新辅助伊马替尼治疗后行该手术的直肠胃肠道间质瘤患者。
沿骶骨岬附近开始由内侧向外侧腹膜后解剖，保留自主神经下行至盆底部进入肛管，不分离肠系膜下动脉，进行直肠解剖。在腹腔镜放大视野下仔细进行肿瘤与前列腺之间的解剖。然后，通过经肛门入路完成腹腔镜与经肛门解剖之间的环形连接，并经肛门取出直肠。通过经肛门入路行直肠全层圆形局部切除和手工直线直肠肛门吻合。
该手术的安全性和可行性是本研究的主要观察指标。
中位手术时间为 180 分钟，中位估计出血量为 115ml。无中转开腹或术中并发症，1 例术后发生肠梗阻，经保守治疗后恢复。所有患者均获得阴性切缘（R0），其中 1 例达到病理完全缓解。
本研究受到患者数量较少的限制。
改良腹腔镜经括约肌间切除术是一种治疗非常靠近肛门的直肠胃肠道间质瘤的新颖而安全的方法（详见视频，补充数字内容 1，http://links.lww.com/DCR/A139）。
