Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter:A report of 82 cases

AIM:To assess the feasibility and efficacy of laparoscopictotal mesorectal excision (LTME) of low rectal cancer withpreservation of anal sphincter.METHODS:From June 2001 to June 2003,82 patients withlow rectal cancer underwent laparoscopic total mesorectalexcision with preservation of anal sphincter.The lowest edgeof tumors was below peritoneal reflection and 1.5-7 cm fromthe dentate line (1.5-5 cm in 48 cases,5-7 cm in 34 cases).RESULTS:LTME with anal sphincter preservation wasperformed on 82 randomized patients with low rectalcancer,and 100% sphincter preservation rate wasachieved.There were 30 patients with laparoscopic lowanterior resection (LLAR) at the level of the anastomosisbelow peritoneal reflection and 2 cm above from the dentateline;27 patients with laparoscopic ultralow anteriorresection (LULAR) at the level of anastomoses 2 cm belowfrom the dentate line;and 25 patients with laparoscopiccoloanal anastomoses (LCAA) at the level of the anastomosesat or below the dentate line.No defunctioning ileostomywas created in any case.The mean operating time was120 minutes (ranged from 110-220 min),and the meanoperative blood loss was 20 mL (ranged from 5-120 mL).Bowel function was restored and diet was resumed on day1 or 2 after operation.The mean hospital stay was 8 days(ranged from 5-14).Postoperative analgesics were usedin 45 patients.After surgery,2 patients had urinaryretention,one had anastomotic leakage,and another 2patients had local recurrence one year later.No interoperativecomplication was observed.CONCLUSION.LTME with preservation of anal sphincter isa feasible,safe and minimally invasive technique with lesspostoperative pain and rapid recovery,and importantly,ithas preserved the function of the sphincter.