Comparison Of Laparoscopic-assisted Transanal And Transabdominal Total Mesorectal Excision

Objective: The incidence of rectal cancer is increasing in China.For patients who meet the requirements,radical resection of rectal cancer is the main treatment.As the recognized gold standard,total mesorectal excision is the first choice of radical resection of rectal cancer.Because the lesion site of the lower rectum is close to the anus,the traditional laparoscopic-assisted total mesorectal excision is difficult in the fine operation of the pelvis and peri-rectal mesorectum.Since 2014,La-taTME surgery has been carried out at home and abroad.Compared with the traditional LapTME,laparoscopic transabdominal assisted operation while transanal approach is used to treat the distal part of the tumor,and the distal structure of the tumor is magnified by the endoscopic structure.The sample was taken out through the anus to achieve the effect of low anus preservation.The main purpose of this study is to study the difference between traditional LapTME and La-taTME in the treatment of low rectal cancer.Methods: The clinical data of 49 patients with rectal carcinoma from Aug.2017 to Jun2021 were retrospectively analyzed in our hospital.Average age of patients is（68.65±5.52）years old,Average body mass index is（22.73±1.47）kg/㎡.21 patients in the observation group were treated with laparoscopic-assisted transanal total mesorectal excision.28 patients in the control group underwent laparoscopic total mesorectal,Statistical methods were used to compare the two groups of related indicators.Results:1.The basic data of the two groups before operation: the patients in the La-taTME group and the LapTME group met the inclusion criteria,and there was no significant difference between the two groups（P > 0.05）.2.The perioperative indexes of the two groups: compared with the LapTME group,the intraoperative blood loss,operation time,anus preservation rate and specimen integrity rate of the La-taTME group were（75.00 ±12.65）ml,（167.38 ±14.92）min,and（100%）,respectively.In La-taTME group,the operation time was shorter and the amount of intraoperative blood loss was less.The sphincter preservation rate and specimen integrity rate of La-taTME group were significantly better than those of LapTME group.There was no significant difference in the positive rate of circumferential margin,the positive rate of distal margin and the number of dissected lymph nodes between La-taTME group and LapTME group.3.Postoperative indicators of the two groups: postoperative condition: after anal exhaust in La-taTME group and LapTME group,there was no obvious discomfort after drinking water on the third day after operation.There was no significant difference in intestinal recovery time between La-taTME group and LapTME group.The hospitalization time of La-taTME group was shorter than that of LapTME group,and the Somatosensory of LataTME group was better than that of LapTME group.4.Comparison of postoperative complications between the two groups: in the observation group,1 case had complications on the 5th day after operation,no obvious anal exhaust and defecation,abdominal standing X-ray showed incomplete intestinal obstruction of the small intestine,and was given symptomatic support treatment such as fasting water,spasmolysis and fluid rehydration.7 days after operation,normal anal exsufflation and defecation were found,and no discomfort was found after flowing food.One patient in the control group developed abdominal infection on the 4th day after operation.after symptomatic treatment such as anti-infection,the abdominal infection disappeared on the7 th day.There was no significant difference in the incidence of postoperative complications between the two groups（P > 0.05）,as shown in Table 4.Before the return visit,there were no tumor recurrence and death in the whole group.5.Comparison of inflammatory factors between the two groups: there was no significant difference in serum CRP and IL-6 between the two groups on the 1st day before operation and the 1st,3rd and 5th day after operation.Conclusion: Compared with LapTME,La-taTME can be operated through abdomen and anus simultaneously,which can guarantee the quality of surgery without increasing the risk of postoperative infection.Ultra-low anal preservation has obvious advantages.less surgical trauma,shorter postoperative recovery time and more comfortable body sensation.Therefore,on the premise of strictly grasping the surgical indications and essentials of operation,La-tatme can further benefit this people of low rectal cancer.