eP191 - Laparoscopic Transanal One-stage Pull-through Coloanal Anastomosis with No Protective Stoma in the Anal Preservation Treatment of Low Rectal Cancer

Purpose/Background: To investigate the application value of laparoscopic transanal one-stage pull-through coloanal anastomosis with no protective stoma (LOPC)in the anal preservation treatment of low rectal cancer.Methods/Interventions: Retrospective analysis of the clinical and pathological data of 19 patients with T1-T2 stage low rectal cancer treated with LOPC from February 2020 to February 2023. There were 9 males and 10 females, all patients underwent LOPC. The distance between the lower edge of the tumor and the anal edge was 3-4cm, the diameter of the primary tumor was less than or equal to 3cm.
The specific surgical steps are as follows (as shown in Figure 1).
Conventional laparoscopic TME was performed. After exploring the abdominal cavity, the No.253 lymph nodes were dissected, the left colon artery was preserved, the superior rectal artery and the sigmoid colon artery were severed. After dissection of the mesorectum along the layer of the planned total mesorectal excision, the Hital ligament was transected to reach the intersphincteric space (between the internal and external anal sphincters (Figure 1A), then splenic flexure was completely taken down, and the left colon was fully mobilized (Figure 1B).Following disinfection of the perineum and anus, and repeatedly rinsed the intestinal cavity with iodophor solution, the skin of the anal verge should be pulled and fixed in all directions using at least 8 No.1-0 mousse threads with a self-made anal dilator (Figure 1C). About 0.5-1cm away from the tumor, the No.2-0 mousse threads were used to suture and fix the rectal mucosa and submucosa, as the traction lines at four quadrants (Figure 1D). After an incision was placed at the far edge of the traction line, the the conjoined longitudinal muscle between the internal and external sphincters was incised (Figure 1E) and dissection continued along the levator ani in the intersphincteric plane to connect with the pelvic dissection from the abdominal approach. Pull out the rectum, tumor, and sigmoid colon through the anus. the colonic seromuscular layer is fixed to the levator ani muscle at the plane of the levator ani muscle hiatus, ensuring that the suture position is at least 5cm away from the proximal cutting edge (Figure 1F).About 10cm away from the proximal stump of the tumor，the rectum was disconnected (Figure 1G), the inner anal intestinal cavity was disinfected again.The entire layer of the colon and the cutting edge of the anal canal were sutured intermittently in four quadrants with the No.2-0 mousse threads, and the 4-0 Vicho threads were intermittently sutured to complete manual end-to-end anastomosis of the colon and anal canal (Figure 1H). The pelvic drainage tube was rinsed and placed under laparoscopy.Results/Outcomes: All 19 patients successfully completed LOPC and retained their anus, without any conversion to open surgery or changes in surgical methods. The median surgical time was 200 (115-280) minutes, with a median bleeding volume of 100 (50-200) milliliters. No protective stoma was performed, and all patients were eligible for R0 resection. An average of 17 (12-26) lymph nodes were cleared, and the average hospital stay was 10 (7-13) days. There were no postoperative anastomotic leakage or perioperative deaths. All patients received postoperative follow-up, with a median follow-up of 12 months (6-40 months) and a LARS score of 26 (19-40 points) at 6 months postoperatively. There was no tumor recurrence or metastasis during the follow-up period.Conclusion/

Discussion: LOPC is safe and effective for the treatment of low rectal cancer.1EDisconnect the distal end of rectum at the safe margin between the internal and external sphincter1FTake out the specimen through the anus, and suture the omentum and seromuscular layers of the colon and the levator ani muscle hiatus1GDissociate the proximal colon1Hsuture the full layer of colon and anal stumps by simple interrupted suture