Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Tech Coloproctol. 2023 Jan;27(1):75-81. doi: 10.1007/s10151-022-02677-y. Epub 2022 Aug 27.
The management of low rectal cancer is a perennial challenge for colorectal surgeons. The benefits of transanal total mesorectal excision (TaTME) in low rectal cancer are to secure the distal margin and avoid surgical space constraints within the deep pelvis. However, anastomotic leak remains an important concern. We report our technique and results combining TaTME with delayed coloanal anastomosis (DCAA) without bowel diversion. First, the splenic flexure, left colon and rectum are laparoscopically mobilized to mid-rectum. TaTME is performed to complete the distal rectal mobilization, and the specimen is delivered transanally and transected. The abdominoperineal colonic pull-through is secured to the anal canal and hypertonic dressing is applied regularly in the ward. The handsewn DCAA is performed one week later. An accompanying video demonstrates this technique. Five consecutive patients with low rectal cancer underwent TaTME with DCAA. All had upfront surgical resection except one who underwent total neoadjuvant therapy. Mean operative duration, blood loss, and length of hospital stay was 290 (250-375) min, 142 (10-200) ml and 11.6 (10-14) days respectively. One patient (20%) suffered a postoperative complication of persistent urinary retention, requiring an indwelling urinary catheter on discharge. There were no cases of open conversion and no instances of anastomotic leakage. Two patients (40%) had minor low anterior resection syndrome (LARS) and one (20%) had major LARS. TaTME and DCAA without stoma are complimentary techniques that augment the minimally invasive effects of laparoscopic sphincter-sparing low rectal cancer surgery, with good perioperative outcomes.
低位直肠癌的治疗一直是结直肠外科医生面临的挑战。经肛门全直肠系膜切除术（TaTME）治疗低位直肠癌的优势在于确保远端切缘，并避免深部骨盆内的手术空间受限。然而，吻合口漏仍然是一个重要的关注点。我们报告了我们的技术和结果，将 TaTME 与无肠转流的延迟结肠肛管吻合术（DCAA）相结合。首先，腹腔镜游离脾曲、左半结肠和直肠至中下段直肠，行 TaTME 完成远端直肠游离，标本经肛门取出并切断。经腹会阴结肠拖出至肛管，并在病房常规使用高张敷料。一周后行手工 DCAA。一个相关视频演示了该技术。5 例低位直肠癌患者接受了 TaTME 联合 DCAA 治疗。除 1 例患者接受了新辅助治疗外，所有患者均进行了一期手术切除。平均手术时间、出血量和住院时间分别为 290（250-375）min、142（10-200）ml 和 11.6（10-14）天。1 例患者（20%）发生术后持续性尿潴留并发症，出院时需留置导尿管。无中转开放病例，无吻合口漏发生。2 例患者（40%）发生轻微低位前切除综合征（LARS），1 例患者（20%）发生严重 LARS。TaTME 联合 DCAA 无造口术是一种补充技术，可增强腹腔镜保肛低位直肠癌手术的微创效果，具有良好的围手术期结果。
