Clinical Research Of Transanal Specimen Extraction In Laparoscopic Colorectal Cancer Surgery

Objective: To explore the safety and advantage of transanal specimen extraction in laparoscopiccolorectal cancer surgery.Methods:Clinical data of29patients with colorectal carcinoma wascollected in Gastrointestinal Department,Shenzhen People’s Hospital from Sep2010to Feb2012.in which13cases were assigned to a transanal specimen extraction procedure,meanwhile16cases were assigned to a transabdominal specimen extraction procedure.After dissecting thePeritoneum and before suturing Peritoneum,500ml physiologic saline solution was infused intoperitoneum lavage.To compare the two specimens of abdominal surgery lavage fluid the positiverate of tumor cells and abdominal lavage appear carcinoma embryo antigen (CEA) values.Beforecolorectal anastomosis,500ml physiologic saline solution was instilled into rectum to irrigate thestump.To compare the two specimens of rectal washout fluid the positive rate of tumor cells.postoperative hospital stay and the recovery of gastrointestinal function by recording recovery ofbowel sounds,the first time of exhaust and defecation and complications were observed.Results: The procedure was successful in all cases.There were no mortality.In the first ofperitoneal lavage fluid,exfoliated malignant cells were fond in1samples(3.4percent).Exfoliatedmalignant cell was demonstrated in0samples of the research group (0percent),and in1samplesof the control group (6.3percent). the positive ratio was not statistically significant differentbetween two groups(P>0.05).In the second of peritoneal lavage fluid,CEA amounts and checkingpositive rate of tumour cells increased and increment had significance.The difference of theincrement between research group and control group has not statistical significance(P>0.05).Inthe rectal washout fluid,exfoliated malignant cell was demonstrated in4samples of the researchgroup (30.8percent),and in5samples of the control group (31.3percent).the positive rate oftumor cells was not statistically significant difference between the two groups(P>0.05).Therewas significant difference of recovery of bowel sounds and the first exhaust defecation timebetween two groups(P<0.05).The difference of the analgesic number between two groups hasstatistical significant(P<0.05).However,hospital stay and complications had not statisticaldifference between two groups(P>0.05).Conclusions:1.The mesorectum of patients are not particularly hypertrophic and tumorsize<5cm, the procedures of transanal specimen extraction in laparoscopic resection for sigmoidand rectal is safe and technically feasible.2.It has such advantages as eliminates abdominal specimens incision,less trauma and short time of recovery.It has not add complications.It alsofollowed the principles of oncological sugery such as no-touch-technique,en-bloc-resection andtumor-free margin.3. It is impossible to avoid the malignant cells exfoliating in abdominal cavityand anastomotic. Therefore,we must adopt a standardized irrigate methods.