Transanal Total Proctocolectomy with Ileal Pouch-Anal Anastomosis for Synchronous Triple Colorectal Cancer

Area of Science:

• Minimally Invasive Surgery
• Colorectal Surgery
• Surgical Oncology

Background:

• Transanal total mesorectal excision (TME) is an established minimally invasive technique for rectal cancer.
• While hybrid and laparoscopic-assisted transanal TME are common, pure natural orifice transluminal endoscopic surgery (NOTES) for colon resection remains less reported.
• This case report addresses the application of transanal laparoscopic techniques for total colectomy.

Purpose of the Study:

• To demonstrate the feasibility of a transanal laparoscopic technique for performing a total colectomy.
• To report on a case of transanal total proctocolectomy with ileal pouch-anal anastomosis for synchronous triple colorectal cancer.
• To highlight the potential for adapting NOTES principles to colonic resection.

Main Methods:

• A transanal laparoscopic total proctocolectomy with intracorporeal ileal pouch-anal anastomosis was performed in a patient with synchronous ascending colon, rectosigmoid colon, and rectal cancer.
• Conventional laparoscopic instruments and long-shafted instruments were utilized for specimen mobilization and dissection.
• The entire specimen was extracted transanally, and a circular stapler was used for anastomosis without a defunctioning stoma.

Main Results:

• The procedure took 328 minutes with <50 mL blood loss.
• Sixty-one lymph nodes were harvested, with one regional metastasis identified.
• The patient experienced a temporary paralytic ileus, was discharged on postoperative day 10, and had no major complications or incontinence at 24-month follow-up, with no evidence of recurrence.

Conclusions:

• Transanal laparoscopic total colectomy is a feasible technique for extensive colonic resection.
• This approach may pave the way for future natural orifice surgery in colonic resections.
• The technique demonstrated safety and efficacy in managing synchronous triple colorectal cancer.