Laparoscopic Pull-through Procedure With Delayed Coloanal Anastomosis Versus Low Anterior Resection With Double-stapler Anastomosis For Low Rectal Cancer: A Comparative Study

Objective:To investigate the effect of laparoscopic pull-through procedure with delayed coloanal anastomosis and low anterior resection with double stapling for low rectal cancer on the short-term effects,postoperative complications,and postoperative anal function in patients.Methods:Select the fellowship at China-Japan union hospital of Jilin university between January 2017 and July 2019 were met inclusion and exclusion standard of 62 patients with low rectal cancer(cancer under the pole pitch dentate line ?7cm),according to the digestive tract reconstruction methods are divided into pull-through anastomosis group(24 cases)and double-stapling anastomosis group(38 cases).Collected the clinical data of two groups of patients(tumor from anal edge distance,preventive colostomy rate,operation time,length of hospital stay and pathological data of tumour is apart from the cut edge distance,the lymph node the circumferential cutting edge negative number),the postoperative complications of cases,anastomotic leakage,anastomotic bleeding,benign anastomotic stricture,rectovaginal fistula,infection of anus week gap,external colon necrosis,colostomy complications,rectal prolapse)were analyzed.Patients in the two groups were evaluated according to the standard of xu zhongfa's five tenths at 3 and 6 months after the operation,respectively.Results:All patients in the group were followed up without lost cases.The follow-up deadline was January 2020,with a median follow-up time of 21 months(range of 6-36 months).Short-term postoperative date:In the pull-through anastomosis group,the operative time was(204±39 minutes VS 231±49 minutes P=0.029),and the hospital stay was(9 days VS 11 days P=0.001),stoma rate(0 VS 100% P=0.000)were both better than the double-stapler anastomosis group,with statistically significant differences(P < 0.05).The pull-through anastomosis group was also better than the control group in the distance between tumor and anus(3cm VS 5cm P=0.020).Postoperative complications:Two groups have no statistical significance when compared to the overall incidence of complications(58.3% VS 47.4%,P = 0.400),but the double stapling anastomosis group preventive colostomy complications than pull-through anastomosis group increased,with statistical significance(21.1% VS 0 P = 0.019),while in terms of postoperative anastomotic benign stricture rate pull-through anastomosis group increased significantly in the method of double stapling anastomosis group(37.5% VS 2.6%,P = 0.000),Moreover,single factor analysis of the benign anastomotic stenosis in the pull-through anastomosis group may be related to the retention of the left colonic artery(P=0.013).there was no statistically significant difference in the incidence of anastomotic leakage between the two groups(P=0.063),but the incidence of double-stapler anastomosis group was higher than the pull-through anastomosis group(10.5% vs 0).Postoperative anal function.There was no significant difference between the two groups in the comprehensive scores of anal function at 3 and 6 months after the operation(P > 0.05),but the normal rate of sensory perception in the pull-through anastomosis group was higher than that in the double-stapler anastomosis group at 3 and 6 months after the operation(P=0.049.P=0.007),with statistical significance;Compared with the double-anastomosis group,the pull-through anastomosis group showed statistical significance in the identification of gas and feces(sensory function)at 3 months after the operation(P=0.000),and no significant difference in sensory function between the two groups at 6 months after the operation(P=0.162).The anal control ability of the two groups,the number of defecation per day and the time of each defecation were not statistically significant in comparison with each other at 3 and 6 months after the surgery(P > 0.05).In addition,In terms of tumor radicality,no significant difference was found in lymph node dissection rate,safe distance of distal resection margin,and positive rate of peripheral resection margin between the two groups(P > 0.05).Conclusion:Pull-through anastomosis and double-stapler anastomosis have the same effect in laparoscopic total mesorectal resection of rectal cancer including total postoperative complications,comprehensive anal function score,radical tumor treatment.The incidence of anastomotic leakage in pull-through anastomosis is lower than that in double-stapler anastomosis,which is not statistically significant but is valid in professional field.The pull-through anastomosis avoids the stoma and the complications related to stoma.Pull-through anastomosis can be used when double stapler anastomosis is difficult.In the treatment of low rectal cancer,it is more widely used than double stapler anastomosis,and the postoperative recovery is faster and the hospital stay is shorter.However,the rate of postoperative benign stenosis is high,and regular postoperative nursing may be helpful to prevent the occurrence of postoperative benign stenosis.