[Clinical analysis of 8 cases of laparoscopic combined with colonoscopic transanal total mesorectal resection].

Abstract

Objective: To explore the feasibility and safety of laparoscopic combined with colonoscopic transanal total mesorectal resection (laparoscopic combined with colonoscopic taTME) in the treatment of rectal cancer. Methods: The descriptive case series analysis method was adopted. From October 2023 to February 2024, the Department of Colorectal Surgery of Li Huili Hospital, Ningbo Medical Center, performed laparoscopic combined with colonoscopic taTME on 8 patients with rectal cancer. Among the 8 patients, there were 5 males and 3 females, aged from 56 to 74 years old, with a body mass index (BMI) of 20.3-26.7 kg/m². All patients were pathologically diagnosed with rectal adenocarcinoma. The long diameter of the tumors was 2.0-6.5 cm, the lower edge of the tumors was 3-5 cm away from the anal verge. In terms of tumor TNM staging, there were 2 cases in stage I, 3 cases in stage II, and 3 cases in stage III. The surgical conditions, postoperative curative effects, and the occurrence of complications were observed. Results: All 8 patients successfully completed laparoscopic combined with colonscopic taTME, and there was no conversion to laparotomy. The operative time was 260 to 335 minutes, the intraoperative blood loss was 50 to 100 milliliters, and the distance from the tumor to the anal margin was 0.8 to 2.0 centimeters. All patients in the group underwent protective end ileostomy, and none of them underwent permanent enterostomy. Specimens were removed from the right lower abdomen in 7 cases and through the anus in 1 case. There was no residual cancer cells at the pathological resection margins postoperatively. All patients ambulated on the first day after the operation, and began to eat on the 2nd to 3rd day after the operation. Anastomotic leakage occurred in 1 patient after the operation, and the condition improved after conservative treatment. The length of hospital stay was 21 days. The other 7 patients were discharged from the hospital 8 to 12 days after the operation. Two patients completed the ileostomy closure surgery 3 months after the operation and recovered well. The patients were followed up until April 2024, during which there were no cases of tumor recurrence or death. Conclusion: For appropriate cases, laparoscopic combined with colonoscopic taTME is safe and feasible.