| Objective: This study aim to discuss the safety and feasiblility,and whether this way can improve the rate of anus preservation without increase the postoperative complications.Methods : A total of 200 patients with mid-low rectal cancer in our hospital from June 2016 to January 2019 were collected.Patients were divided into two groups,106 patients were in the pushing anus group,94 patients in the without pushing anus group.Inclusion criteria were:(1)aged 18-80 years;(2)Lower margins of the tumor between 4 and 10 cm from the anal edge;(3)the primary tumor diameter less than 5cm;(4)preoperative pathology examination proven rectal cancer;(5)magnetic resonance imaging(MRI)in the diagnosis of clinic stage T1-3Nx M0(clear circumferential resection margin);(6)no intestinal obstruction or intestinal perforation;(7)through the medical ethics committee,patients and their families provide written informed consent.Exclusion criteria:(1)inability to communicate normally;(2)patients with intestinal obstruction or perforation;(3)MRI in the diagnosis of clinic stage T4 or with distant metastasis despite in the diagnosis of clinic stage t1-3 or involved circumferential resection margin;(4)preoperative assessment of coronary heart disease,pulmonary infection and other surgical contraindications;(5)the patients do not agree were included in the study.Carefully assess the clinic date of patients enrolled in the study,including history collection,physical examination,blood routine,blood biochemistry,tumor markers,blood coagulation routine,colonoscopy,preoperative pathological examination,chest X-ray and MRI.After the improvement of preoperative examination and preoperative preparation,laparoscopic resection for rectal cancer was performed by the same experienced surgery group both of all the patients.Patients in the pushing anus group were pushed by an assistant during the operation,while patients in the without pushing anus group received conventional laparoscopic surgery.The date acquisition were: age,gender,ASA classification,TNM stage,mean distance from the anal edge,body mass index(BMI),tumor diameter,differentiation,location of the tumor,operation time,blood loss,rate of anus preservation,tumor distance from the resection margins,harvested lymph nodes,the number of staple cartridges used in intraoperative,hours until out of bed,time of anus exhaust defecation,defecation,plasma drainage tube removal,hospital stay and postoperative anastomotic bleeding and anastomotic leakage were analyzed.Results: There were no significant difference between the two groups in age,gender,ASA classification,TNM stage,mean distance from the anal edge,body mass index(BMI),tumor diameter,differentiation and location of the tumor(P>0.05).The two groups were all successfully completed by the same surgery group,and no transfer to open the abdomen.The operation time was 160.94±11.47 minutes in the pushing anus group and 156.43±18.79 minutes in the without pushing anus group,there was no significant difference(P=0.060);the blood loss was 28.49±21.12 ml in the pushing anus group and 33.82±9.55 ml in the without pushing anus group,and there was no significant difference(P=0.055).The detailed distances from the anal edge in the pushing anus group: 15(14.2%)patients between 4.0 and 4.9 cm,19(17.9%)patients between 5.0 to 5.9 cm,72(67.9%)patients between 6.0 and 10.0 cm.The detailed distances from the anal edge in the without pushing anus group: 14(14.9%)patients between 4.0 and 4.9 cm,20(21.3%)patients between 5.0 to 5.9 cm,60(63.8%)patients between 6.0 and 10.0 cm.And there was no significant difference(P=0.805).The anus were preserved in 96(90.6%)patients in the pushing anus group,while 67(71.3%)patients in the without pushing anus group,the difference between the two groups were statistically significant difference(P<0.001).In the pushing anus group,17(17.7%)patients required 1 staple cartridge,77(80.2%)patients required 2 staple cartridges and 2(2.1%)patients required 3 staple cartridges;in the without pushing anus group,2(3.0%)patients required 1 staple cartridge,47(70.1%)patients required 2 staple cartridges and 18(26.9%)patients required 3 staple cartridges,the difference between the two groups were statistically significant difference(P<0.001).There were no significant difference between the two groups in tumor distance from the resection margins,harvested lymph nodes,hours until out of bed,the time of anus exhaust defecation,defecation,plasma drainage tube removal and hospital stay(P>0.05).On the basis of keeping the anus,1(1.0%)patient in the pushing anus group and 6(9.0%)patients in the without pushing anus group suffered from postoperative anastomotic bleeding,and there were a significant difference between the two groups(P=0.020).2(2.1%)patient in the pushing anus group and 7(10.4%)patients in the without pushing anus group suffered from postoperative anastomotic leakage,and there were a significant difference between the two groups(P=0.033).Conclusions:(1)There are no significant difference between the group pushing anus and the normal laparoscopic resection for mid-low rectal cancer in operation time,blood loss,tumor distance from the resection margins,harvested lymph nodes,hours until out of bed,the time of anus exhaust defecation,defecation,plasma drainage tube removal and hospital stay.Pushing the anus is a safe and viable method in laparoscopic surgery for mid-low rectal cancer.(2)For tumors with the lower margin between 4.0 cm and 5.9 cm from the anal edge,the rate of anus preservation in the pushing anus group was significantly higher than the without pushing group.For tumors with the lower margin between 6.0 cm and 10.0 cm from the anal edge,the rate of anus preservation were no significant difference between the two groups,but postoperative complications such as anastomotic bleeding and anastomotic leakage were significantly lower in the pushing anus group than in the without pushing group.There was no significant difference in postoperative anus defecation time and postoperative anus defecation function between the two groups.The method not only effectively improved the rate of anus preservation,but also protected the anus function.(3)The method pushing the anus use more less staple cartridges than the normal laparoscopic resection for mid-low rectal cancer.(4)After pushing the anus,can reduce the traction and tension when the rectum is cut and closed under endoscopy,the effect of staple cartridge is better,patients suffer from the postoperative anastomotic bleeding and anastomotic leakage have a significant reduced. |
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