Laparoscope-assisted superlow anterior resection combined with inter sphincteric rectal dissection for very low advanced rectal cancers combined with preoperative chemotherapy.

ABSTRACT

Transanal intersphincteric resection (ISR) has been increasingly used as a surgical treatment for extremely low rectal cancer. We hypothesized that high quality less invasive surgery could be achieved if ISR and laparoscopic surgery were combined. The patient was a 46-year-old male with advanced rectal cancer on the lower rectum adjacent to the dentate line. The patient refused abdomino-perineal resection (APR), so we performed laparoscope-assisted ISR after preoperative chemotherapy. Previous dissection of this patient facilitated the muscle layer-oriented curative dissection, and more importantly, made the subsequent laparoscopic rectal excision effortless. This patient showed favorable recovery including postoperative anal function with no complications or recurrent disease. This procedure is feasible and has favorable short-term results for the radical treatment of very low rectal disease, while preserving anal function. This operative procedure may be appropriate for locally advanced rectal cancers to avoid a permanent colostomy.