Laparoscopic Sphincter-Preserving Total Mesorectal Excision With Colonic J-Pouch Reconstruction

Tsang, W.W.C.; Chung, C. C.; Kwok, Sui-Yi; Li, Michael K.W.

doi:10.1097/01.sla.0000202180.16723.03

Cited by 75 publications

(71 citation statements)

References 41 publications

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“…16 Similarly, Tsang et al from Hong Kong had only 1 anastomotic leak in their series of 105 laparoscopic rectal cancer resections and Li reported a leak rate of 3.5% in his series of 152 patients. 21,22 Laparoscopic TME has the potential to achieve better preservation of the pelvic autonomic nervous system because the magnified operative view allows easier identification of pelvic nerves. Liang et al studied 98 patients with T3 mid or low rectal cancers undergoing laparoscopic TME following neo-adjuvant chemo-radiotherapy.…”

Section: Potential Benefits Of Laparoscopic Rectal Cancer Surgerymentioning

confidence: 99%

Laparoscopic surgery for rectal cancer

et al. 2012

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SummaryLaparoscopic surgery for colonic cancer is a safe and established alternative to traditional open colectomy. The potential advantages of shorter length of stay, faster recovery and fewer operative complications are well documented. The last 5 years has seen an increase in the number of laparoscopic colorectal operations as more surgeons learn this technique. Short and medium term results have been encouraging with respect to oncological outcomes. However, laparoscopic surgery for rectal cancer remains a contentious issue. The increased complexity of operating within the confines of the pelvis and the greater risk of oncological compromise, have led to some surgeons urging caution. We present the challenges associated with laparoscopic rectal cancer surgery and explain that appropriate patient selection, surgical planning and laparoscopic experience are the key to successful outcomes.

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Section: Potential Benefits Of Laparoscopic Rectal Cancer Surgerymentioning

confidence: 99%

Laparoscopic surgery for rectal cancer

et al. 2012

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“…Recent studies (14)(15)(16) reported the feasibility of total colectomy or proctocolectomy using a laparoscopic approach. We selected a hand-assisted approach for this case in order to maintain a clean operative field by blocking the dilated colon with the surgeon's hand.…”

Section: Discussionmentioning

confidence: 99%

Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

et al. 2012

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“…The level of the coloanal anastomosis was a median 3.5 (0-4.5) cm from the anal verge; a coloanal pull-through anastomosis was required in one patient who had a distal cancer. The ileostomies functioned and patients tolerated free fluids at a median of two (1-9) days, and the median postoperative hospital stay was seven (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days. At a median follow-up of 14 (2-33) months, none of the adenocarcinoma patients who had lmdergone curative resection had recurrences.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic Ultralow Anterior Resection with Colonic J-pouch-Anal Anastomosis

Selvindos¹,

Ho²

2008

Diseases of the Colon &Amp; Rectum

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PURPOSE: Optimal treatment of mid to distal rectal cancers includes total meso rectal excision for oncologic clearance and, where reanastomosis is feasible, a colonic J-pouch-anal anastomosis improves bowel function. There is recent interest in performing an ultralow anterior resection laparoscopically. 1-3 A technique is described that includes specimen extraction through the eventual routine dcfunctioning COlOStOll1Y or ilcosto111Y site. METHODS:Consecutive unselected patients who underwent laparoscopic ultralow anterior resection were recruited. Patients \-vith adenocarcinOlna underwent preoperative endorectal ultrasound to individualize for neoadjuvant chemoradiotherapy, based on local extent and lymph nodes seen. The operative procedures were as shown in the video. Posterior dissection along the "total mesorectal excision plane" included incision ofWaldeyer's fascia. Bowel continuity was restored by an intracoporeal double-cross stapled colonic I-pouch-anal anastomosis, but where not possible a coloplasty with pull-through handsewn coloanal anastOlllosis was performed. (n = I), and carcinoid with local lymph node metastases (n=I). The adenocarcinomas were a median distance of 6 (3-12) cm from the anal verge. Neoadjuvant radiotherapy was given in 12 patients (24 percent) who had preoperative endoanal ultrasound lindings of tumor extension beyond the muscularis propria and chemoradiotherapy in 7 (14 percent) of these patients where the tumor was more bulky and fIxed. Laparoscopic ultralow anterior resection was completed at a median 180 (90-405) minutes, with 53.5 (2-2250) ml of blood loss, and the specimen was extracted Electronic supplementary material The online version of lhis arLide (doi:l0.l007/s10350-008-9322-4) contains supplementary material, which is available to authorized users. through a 4.5 (3.5-11) cm wound. The latter included three cases (5 percent) that were converted. SignifIcant adhesiolysis was required in 29 patients (52.7 percent) because of previous operations. The histologic grading or the adenocarcinoma patients were: Stage I, n=14; Stage II, n=23; Stage III, n= 11; Stage IV, n=3. Of those who underwent curative resection (Stages I-IIO, the distal resection margin was 2.9±0.7 cm (mean±standard error) and the radial resection n1m'gins ,,,ere at least 2 mn1 in all patients. The level of the coloanal anastomosis was a median 3.5 (0-4.5) cm from the anal verge; a coloanal pull-through anastomosis was required in one patient who had a distal cancer. The ileostomies functioned and patients tolerated free fluids at a median of two (1-9) days, and the median postoperative hospital stay was seven (3-22) days. At a median follow-up of 14 (2-33) months, none of the adenocarcinoma patients who had lmdergone curative resection had recurrences. Four patients (8 percent) had postoperative complications that required operativelinvasive intervention (anatomotic leak n=l, proximal bowel ischemia n=l, port site hernia n= 1, pelvic collection n= I). Four other patients had smaller pelvic collections ...

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Laparoscopic Sphincter-Preserving Total Mesorectal Excision With Colonic J-Pouch Reconstruction

Abstract: Laparoscopic TME with colonic J-pouch reconstruction is a safe procedure with reasonable operating time and does not appear to pose any threat to the oncologic and functional outcomes.

Cited by 75 publications

References 41 publications

Laparoscopic surgery for rectal cancer

Laparoscopic surgery for rectal cancer

Hand-assisted laparoscopic subtotal colectomy with cecorectal anastomosis for chronic idiopathic colonic pseudo-obstruction: report of a case

Laparoscopic Ultralow Anterior Resection with Colonic J-pouch-Anal Anastomosis

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