Page 20 - tmp

ORIGINAL ARTICLE
Laparoscopic Intersphincteric Resection and Colon Shaping

for Low Rectal Cancer Treatment

5
4
3
6
2*
1*
Truong Van Nguyen , Minh Quang Dao , Hoa Lam Nguyen , Quyet Van Ha , Thuong Van Pham , Phuoc Van Nguyen ,
7
Thang Quyet Tran , Anh Thuy Tran 8
AbstrAct
Aim and objective: This paper was conducted to examine the results of laparoscopic intersphincteric resection and colon shaping for low
rectal cancer treatment in adults.
Materials and methods: Data were collected, including general characteristics, preoperative and postoperative characteristics, and long-term
treatment outcomes. The Kaplan–Meier survival analysis was performed to assess the survival rate of 48 months after surgery.
Results: Of 43 patients with low rectal cancer, subtotal intersphincteric resection was the primary surgical method at 37.2%. The colon was
mainly shaped “J” at 51.2% of the patients. According to Kirwan classification, there were 83.7% of the patients at grade I; and this rate decreased
to 62.9% after surgery (p <0.05). According to Wexner score, before surgery, 62.8% of the patients had a score <5, which reduced to 48.8% after
surgery (p >0.05). The mean survival time was 41.53 ± 2.37 months, with a cumulative survival probability of 48 months of 78.8%. There was
no difference in survival rate between patients with different stages of cancer and colon shaping.
Conclusion: Laparoscopic intersphincteric resection and colon shaping were effective in low rectal cancer treatment. Colon shaping was an
effective method of improving bowel function in cases of subtotal or total intersphincteric resection.
Keywords: Colon shaping, Laparoscopic surgery, Low rectal cancer.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1473

IntroductIon 1,2 Department of General Surgery, Thanh Nhan Hospital, Hanoi, Vietnam
Low rectal cancer is malignancy, accounting for a high rate of about 3 Hai Phong Oncology Centre, Hai Phong University Medicine and
40–45% of the colorectal cancer diseases. The common treatment Pharmacy, Hanoi, Vietnam
is multimodal therapies that combine surgery and adjuvant 4,5 Department of Surgery, Hai Phong University of Medicine and
therapy, with or without preoperative chemotherapy. In the early Pharmacy, Hanoi, Vietnam
20th century, Ernest Miles’ surgical method was considered the 6 Thanh Nhan Hospital, Hanoi, Vietnam
standard approach for the treatment of low rectal cancer, with 7 Department of Obstetrics and Gynecology, Thanh Nhan Hospital,
abdominoperineal resection. 1,2 Hanoi, Vietnam
In the later stages, the treatment target for low rectal cancer has 8 Department of Functional Test, National Hospital of Traditional
changed. In addition to the three primary goals of the treatment, Medical, Hanoi, Vietnam
including increasing survival, improving quality of life, and reducing *
recurrence rates, preserving the function of patients after treatment Equally contributed to this manuscript
has been set as a priority to ensure rectal cancer patients’ quality of Corresponding Author: Truong Van Nguyen, Department of General
life. In 1972, Park and Percy successfully performed sphincter-saving Surgery, Thanh Nhan Hospital, Hanoi, Vietnam, e-mail: dr.truongnv@
surgery. In 1982, Heald introduced a complete mesenterectomy gmail.com
and quickly became standard in rectal cancer surgery. Since then, How to cite this article: Nguyen TV, Dao MQ, Nguyen HL, et al.
the requirement to save sphincters has been prioritized in rectal Laparoscopic Intersphincteric Resection and Colon Shaping for Low
cancer treatment. 3,4 Rectal Cancer Treatment. World J Lap Surg 2021;14(3):162–165.
In 1984, based on the anatomical development of the anorectal Source of support: Nil
region and the discovery of the layer between the two sphincter Conflict of interest: None
muscles and the structure of the sphincter muscles, Rudolf Schiessel
introduced the intersphincteric resection and colo-anal anastomosis
by hand stitching. 5–7 In 2005, Schiessel et al. reported long-term this period over open abdominal surgery, especially in abdominal/
results, providing the foundation for intersphincteric resection pelvic area surgery. Laparoscopic intersphincteric resection has
in rectal cancer surgery. This study also mentioned sphincter become the standard surgical method. 9
1–7
regeneration or using an artificial anal sphincter. In 2010, Bujko et al. However, after surgery for rectal tumors, bowel function
published a study of 948 patients showing that a distance from 1 cm often has disorders due to surgical intervention in the sphincter.
or more from the tumor to the anal margin is sufficient to guarantee Schiessel proposed a method of rectal shaping by the colon
surgical success in terms of oncology. In the group of patients with a to reduce the number of bowel movements while assessing
distance of less than 1 cm or 5 mm, if the disease condition reaches factors influencing the indications for colon shaping and factors
8
7
R0, the rate of local recurrence was 1.7% or lower. In addition, affecting the frequency of defecation after surgery. This study
laparoscopic surgery has been shown to have many advantages over was conducted to evaluate the effectiveness of laparoscopic
© The Author(s). 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.