Efficacy Of Laparoscopic Anterior Resection Of Rectal Cancer With Specimen Extraction Via Stoma Incision Without Abdominal Auxiliary Incision

ObjectiveTo evaluate the safety and feasibility of lapa roscopic anterior resection of rectal cancer with specimen extraction via stoma incision without abdominal auxiliary incision by analyzing retrospectively the clinical data of patients who underwent laparoscopy-assisted anterior resection of middle and lower rectal cancer and the prophylactic ileostomy with specimen extraction via a traditional abdominal auxiliary incision and with specimen extraction via stoma incision without abdominal auxiliary incision.MethodsMedical records of patients who underwent laparoscopy-assisted anterior resection of middle and lower rectal cancer and prophylactic ileostomy in the General Surgery Department of Fuyang People’s Hospital from December 2018 to April 2021 were collected.A total of 56 patients were collected acoording to inclusion criteria and exclusion criteria.According to whether or not specimen extraction via stoma incision,the patients were divided into two groups.The patients who underwent specimen extraction via stoma incision were included into the study group（the stoma group）.The patients who underwent specimen extraction via a traditional abdominal auxiliary incision were included into the control group（the conventional group）.General data（gender,age,BMI,tumor size,tumor location,tumor stage,whether or not to preserve the left colonic artery）,perioperative data（operation time,postoperative exha ust time,postoperative feeding time,postoperative hospitalization time,postoperative pain score）,recent postoperative complications（infection of incision,intestinal obstruction,anastomotic leakage,anastomotic bleeding,pulmonary infection）and posto perative data of follow-up（astomy related complications and tumor recurrence and metastasis）were counted.IBM SPSS Statistics22.0 software was used for data analysis.Corresponding statistical methods were used for data analysis.P<0.05 was considered as statistically significant difference.Results1.General data:There were 32 people in the stoma group,of whom 22 were men and 10 were women;there were 24 people in the conventional group,of whom 16 were men and 8 were women.The average age of the stoma group was 62.09±10.40 years,and the average age of the conventional group was 60.91±14.90 years.The average Body Mass Index of the stoma group was 22.37±3.34Kg/m2,the average Body Mass Index of the conventional group was 23.53±2.73Kg/m2.The median tumor size was 3.5（2.5,4.875）cm in the stoma group and the median tumor size was 4（3.05,5.0）cm in the conventional group.There were 23 people in the middle rectum of the tumor position and 9 people in the lower rectum in the stoma group;there were 19 people in the middle rectum of the tumor position and 5 people in the lower rectum in the conventional group.There were 8 people in stage Ⅰ,2 people in stage Ⅱ and 22 people in stage Ⅲ in the stoma group about the cTNM stage,and while there were 2 people in stage Ⅰ,4 people in stage Ⅱ and 18 people in stage Ⅲ in the conventional group.There were 16 people in the stoma group who preserved the left colon artery and 16 people who did not preserve;there were 14 people in the conventional group who preserved the left colon artery and 10 people who did not preserve.There were no statistically significant differences between the two groups in terms of sex,age,BMI,tumor size,tumor location,tumor stage,and whether or not to preserve the left colonic artery（P>0.05）.2.Perioperative data:The operation time in the stoma group（206.72±47.97min）was shorter than that in the conventional group（241.04±69.17min）（P=0.044）.The postoperative hospitalization time in the stoma group[9（8,10.75）d]was shorter than that in the conventional group[11（9.25,16.5）d]（P=0.011）.The pain score on the 8th hour after surgery in the stoma group[2.5（2,3）]was lower than that in the conventional group[3（3,3）]（P=0.04）.The pain score on the 24th hour after surgery in the stoma group[2（2,2）]was lower than that in the conventional group[3（2,3）]（P=0.031）.The differences of the above indexes were statistically significant.There were no statistically significant differences in postoperative exhaust time,postoperative feeding time,and pain score on the 72th hour after surgery between the two groups（P>0.05）.3.Recent postoperative complications:There were 5 cases of com plications in the stoma group（15.6%）.There were 9 complications in the conventional group（37.596）.The incidence of com plications in the stoma group was lower than that in the conventional group,but the difference was not statistically significant（P=0.061）.4.Postoperative data of follow-up:All patients were followed up for 3 to 12 months.There were 5 cases of fecal dermatitis and 1 case of parastomal hernia in the stoma group with a total incidence of 18.7%.There were 4 cases of fecal dermatitis in the conventional group with a total incidence of 16.696.There were 2 cases of distant metastases in the stoma group with an incidence of 6.3%and 3 cases of distant metastases in the conventional group with an incidence of 12.5%.There were no local recurrences or tumor implantation in the stoma in either group.There were no significant differences in terms of ostomy related complications and tumor recurrence and metastasis between the two groups（P>0.05）.ConclusionSpecimen extraction via stoma incision without abdominal auxiliary incision could reduce abdominal incisions and reduce surgical trauma and reduce operative time and alleviate postoperative pain and facilitate postoperative rehabilitation effectively without increasing the incidence of postoperative complications.It was safe and feasible in laparoscopic anterior resection of rectal cancer.