Laparoscopic-Assisted Modified Intersphincter Resection for Ultralow Rectal Cancer

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Intersphincter resection (ISR) is a key technique for ultralow rectal cancer, aiming for sphincter preservation.
• High-definition laparoscopy enhances ISR visibility in the pelvic cavity.
• However, suboptimal functional outcomes, including anal incontinence, remain a challenge after ISR.

Purpose of the Study:

• To introduce and evaluate a novel laparoscopic-assisted modified ISR technique.
• The primary aim is to improve sphincter function following ISR for ultralow rectal cancer.

Main Methods:

• A 62-year-old female patient with stage I ultralow rectal cancer underwent laparoscopic-assisted modified ISR.
• The procedure involved abdominal (colonic mobilization, total mesorectal excision, transabdominal intersphincteric dissection) and perineal phases.
• A modified resection technique preserved the dentate line, followed by handsewn coloanal anastomosis and a temporary stoma.

Main Results:

• The surgery was completed without intraoperative complications in 180 minutes with 50 mL blood loss.
• Pathology confirmed clear distal margins (pT2N0M0).
• At 12-month follow-up, the patient demonstrated complete continence to solids, liquids, and flatus, with no recurrence.

Conclusions:

• Laparoscopic-assisted modified ISR is a safe and feasible approach for ultralow rectal cancer.
• This technique offers potential for improved sphincter preservation and function.
• Consideration of this modified ISR is recommended for eligible patients.