Keywords
Colorectal cancer
Natural orifice specimen extraction surgery
Totally laparoscopic
Submitted : 2024-10-26
Accepted : 2024-11-10
Published : 2024-11-25
Abstract
Objective: To explore the value of hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction. Methods: A retrospective descriptive study was conducted. Clinical data of 54 patients with colorectal cancer who underwent total laparoscopic transrectal specimen extraction surgery between January 2019 and December 2023 at the Department of Gastrointestinal Surgery, Bayannur City Hospital, were collected. All patients underwent digestive tract reconstruction using hand-sewn end-to-end colonic or rectal anastomosis. Intraoperative and postoperative general conditions, pathological results, complications, and follow-up data were analyzed. Results: Among the 54 cases, 37 were male, and 17 were female. The cases included 26 sigmoid colon cancers, 27 high rectal cancers, and 1 descending colon cancer. All patients underwent total laparoscopic radical resection of colorectal cancer with transrectal specimen extraction. The average surgical duration was 187.87 ± 61.36 minutes, with 16 (14–19) minutes required for hand-sewn anastomosis. Intraoperative blood loss was 16 (10–200) mL, with no conversions to open surgery or blood transfusions. Postoperative outcomes included first flatus time of 1 (1–3) day, liquid diet resumption on 2 (2–3) days, postoperative Visual Analog Scale (VAS) pain score of 2 (2–3), and hospital stay duration of 8 (7–9) days. The total hospitalization cost was 41,011 (25,655–148,589) Chinese yuan, with an average cost of 42,558.81 ± 8,599.30 Chinese yuan after excluding three cases with complications. Pathological examination revealed all cases to be adenocarcinomas: 20 well-differentiated, 32 moderately differentiated, and 2 poorly differentiated. All resection margins were negative. An average of 16.85 ± 7.97 lymph nodes were dissected. Pathological staging included 18 stage I, 17 stage II, and 19 stage III cases. Postoperative complications included 2 cases of anastomotic leakage (3.7%), 1 case of anastomotic stricture (1.8%), and 1 case of pulmonary infection (1.8%). No unplanned readmissions or postoperative deaths occurred during the 30-day follow-up period. Conclusion: Hand-sewn anastomosis in totally laparoscopic radical resection of colorectal cancer with transanal specimen extraction is safe and feasible.
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