Intersphincteric Resection Using A Prolapsing Technique In The Patients With Low Rectal Cancer

Objection The intersphincteric resection using a prolapsing technique in the patients with low rectal cancer.Material and methodsGeneral condition of the patients23 cases with low rectal cancer admitted into Shandong Qilu Hospital from 2000 to 2004 were enrolled into our study, including 13 males and 10 females, average age 61.4 years. The pathology of all the patients before the operative were adenocarcinoma.The median tumor distance from the anal margin was 4.5(range 3.5-5.0) cm and the mean distal surgical margin 1.6 (range 1.0-2.0) cm.Surgical techniqueThe total mesorectal excision (TME) was performed in the lithotomy position after mechanical bowel preparation.The rectum and mesorectum were mobilized to the pelvic floor to facilitate the perianal procedure.The rectal muscle canal and the internal sphincter were exposed at the pelvic floor and the external sphincter and internal sphincter were separated with scissors or by using blunt dissection. Preserved sigmoid colon was freed by pulling down for coloanal anastomosis.After inspecting the location of the tumor from the abdominal and anal incisions, the colon was pushed gently to the rectal canal and moved in the direction of anus.After the anus was thoroughly dilated, the rectum and tumor were pushed out of the anus,the tumor and dentate line were well exposed.Careful and through irrigation of the prolapsed rectum with distilled water was performed.Cut off the rectum below the tumor-bearing rectum in the rest position and the tumor was excised.The opening of the distal end of the rectum was closed by means of a purse-string suture and a stapling device was applied.The anastomosis was finished the purse-string with the proximate colon after the returning of the residual end of the rectum.ResultThere were no people dead during the peroperative period in this group. Pathology showed that there was no evidence of residual cancer present in the distal, proximal or circumferential incision margins. According to Dukes classification,7 patients (30.4%) were in Dukes A,11 (47.8%) in Dukes B,5 (21.7%) in Dukes C; According to TNM classification,7 (30.4%) in stage T1,13 (13%) in stage T2 and 3 (13.0%) in stage T3. Postoperative complication:Two patients (8.7%) had complications with their anastomatic fistula.Two patients (8.7%) had complications with later-stage strictures at the coloanal anastomosis.All patients were followed for 12 to 54 months (mean 31.5 months). Among these patients, two (8.7%) developed local recurrence, three patients were dead because of the distal metastasis after the operation.20 patients (87.0%) maintained excellent control of solid, liquid stool and flatus.At 3,6,12,24 and 36 months after surgery average daily defecations were 13.1, 4.7,3.1,2.9, and 3.2 times/day, respectively. Postoperative resting pressure dropped significantly at the beginning and then increased slightly later; while the maximum squeeze pressure was significantly restored after an initial postoperative decrease then remained at this level.