Laparoscopic surgery using a Gigli wire saw for locally recurrent rectal cancer with concomitant intraperitoneal...

Previous reports indicated the effectiveness of surgical resection for locally recurrent rectal cancer (LRRC). Most cases with posterior invasion patterns require concomitant sacrectomy to secure negative histologic margins, although this is a highly invasive procedure. Here, we present a new minimally invasive laparoscopic surgical technique for LRRC with concomitant sacrectomy.

A 64-year-old man presented with LRRC on the surface of the sacral bone. He underwent laparoscopic abdominoperineal resection with concomitant sacrectomy below the S4 vertebra. The surgical procedure, including sacrectomy, was performed laparoscopically. The distance between the estimated resection line (below the S4 vertebra) and sacral promontory was measured by preoperative imaging. Intraoperatively, a flexible ruler was employed to determine the resection line. Securing adequate space dorsal to the sacral bone was indispensable for placement of the Gigli wire saw. After the Gigli wire saw was positioned, bilateral caudal trocars were used to remove the ends of the wire. Then, the sacral bone was cut by the linear reciprocating motion of the Gigli wire saw. Pathologically confirmed curative resection was achieved. The procedure was successfully performed without transfusion or intraoperative complications. The operation time was 757 min, and blood loss volume was 890 ml. There were no severe postoperative complications. The patient is alive and well with no evidence of recurrence at 58 months after surgical resection of LRRC.

Our newly developed technique demonstrates that laparoscopic intraperitoneal sacrectomy using a Gigli wire saw is a safe and useful procedure to facilitate resection of LRRC.