Abstract
Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.
Aberrant renal hilar pelvic anatomy in a malrotated kidney
