Uemura Mamoru, Ikeda Masataka, Kawai Kenji, Nishimura Junichi, Takemasa Ichiro, Mizushima Tsunekazu, Yamamoto Hirofumi, Sekimoto Mitsugu, Doki Yuichiro, Mori Masaki
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Asian J Endosc Surg. 2018 Feb;11(1):83-86. doi: 10.1111/ases.12407.
Previous reports indicated the effectiveness of surgical resection for locally recurrent rectal cancer (LRRC). Most cases with posterior invasion patterns require concomitant sacrectomy to secure negative histologic margins, although this is a highly invasive procedure. Here, we present a new minimally invasive laparoscopic surgical technique for LRRC with concomitant sacrectomy.
A 64-year-old man presented with LRRC on the surface of the sacral bone. He underwent laparoscopic abdominoperineal resection with concomitant sacrectomy below the S4 vertebra. The surgical procedure, including sacrectomy, was performed laparoscopically. The distance between the estimated resection line (below the S4 vertebra) and sacral promontory was measured by preoperative imaging. Intraoperatively, a flexible ruler was employed to determine the resection line. Securing adequate space dorsal to the sacral bone was indispensable for placement of the Gigli wire saw. After the Gigli wire saw was positioned, bilateral caudal trocars were used to remove the ends of the wire. Then, the sacral bone was cut by the linear reciprocating motion of the Gigli wire saw. Pathologically confirmed curative resection was achieved. The procedure was successfully performed without transfusion or intraoperative complications. The operation time was 757 min, and blood loss volume was 890 ml. There were no severe postoperative complications. The patient is alive and well with no evidence of recurrence at 58 months after surgical resection of LRRC.
Our newly developed technique demonstrates that laparoscopic intraperitoneal sacrectomy using a Gigli wire saw is a safe and useful procedure to facilitate resection of LRRC.
既往报道表明手术切除对局部复发性直肠癌（LRRC）有效。大多数后侵型病例需要同时行骶骨切除术以确保组织学切缘阴性，尽管这是一种侵袭性很强的手术。在此，我们介绍一种用于LRRC合并骶骨切除术的新型微创腹腔镜手术技术。
一名64岁男性患者，骶骨表面出现LRRC。他接受了腹腔镜腹会阴联合切除术，并在S4椎体以下同时行骶骨切除术。包括骶骨切除术在内的手术过程均通过腹腔镜进行。术前影像学测量估计切除线（S4椎体以下）与骶岬之间的距离。术中，使用柔性尺确定切除线。在骶骨后方确保足够的空间对于放置吉利锯至关重要。放置好吉利锯后，使用双侧尾侧套管针移除锯丝两端。然后，通过吉利锯的直线往复运动切断骶骨。病理证实实现了根治性切除。手术成功完成，未输血，无术中并发症。手术时间为757分钟，失血量为890毫升。无严重术后并发症。患者术后58个月存活良好，无LRRC复发迹象。
我们新开发的技术表明，使用吉利锯进行腹腔镜腹膜内骶骨切除术是一种安全且有用的手术，有助于LRRC的切除。
