Single-port laparoscopic total mesorectal excision with transanal resection (transabdominal transanal resection) for low rectal cancer: Initial experience with 22 cases

Background: Total mesorectal excisions (TME) with transanal resection and coloanal anastomosis (CAA) represent one of the standard surgical treatments for low rectal cancers. We report our initial experiences with trans-abdominal trans-anal resections (TATAR) with TME, performed using a single-port laparoscopic surgeries (SPLS) approach for low rectal cancers. Methods: Between June 2009 and April 2011, 22 low rectal cancer patients underwent SPLS TATAR with TME. SPLS was performed transumbilically or through predetermined stoma sites. Conventional laparoscopic instruments were used, and the intracorporeal procedures and range of operation did not differ. After a full laparoscopic TME to the pelvic floor muscles, the specimen was pulled through the anus. CAA was completed with transanal hand sewn sutures. Patient and tumor characteristics and operative, pathologic, and postoperative outcomes were studied. Results: SPLS TATAR with TME was successful in all patients. No additional incisions for trocars or conversions to open surgery were performed. The median incision length, operative time, and postoperative length of stay were 2.0cm (range: 1.5-2.5), 260min (range: 190-380), and 6 days (range: 4-16), respectively. The median number of harvested lymph nodes was 22 (range: 9-42). The median distal margin from the tumor was 2.0cm (range: 0.3-4.0). No intraoperative complications were noted. Conclusions: SPLS TATAR with TME was safe and feasible. In addition to cosmetic advantages, oncologic requirements for specimens, including adequate margins and sufficient lymph node harvesting could be fulfilled entirely. However, the technique and oncologic safety warrant further evaluation and prospective randomized studies.