Safety and efficacy of partial resection of the dentate line and the full-thickness anal canal after rectal eversion for total laparoscopic ultra-low sphincter preservation
HU Gang
XING Zhao-dong
DU Jin-bo
QIU Wen-long
LI Bo
WANG Yu-han
TANG Jian-qiang
Abstract：Objective To evaluate the safety and anal efficacy of total laparoscopic ultra-low sphincter preservation using partial resection of partial dentate line and full-thickness anal canal after rectal eversion.Methods A retrospective analysis was conducted on clinical data from patients with low rectal cancer(≤1 cm from the dentate line)who underwent the described procedure by the same surgical team at the Colorectal Surgery Department of the Cancer Hospital,Chinese Academy of Medical Sciences,between April 2021 and July 2023.Partial resection of the dentate line and the entire layer of the anal canal under the eversion field of view was adopted.Data including Intraoperative data and perioperative complications was collected,and anal function(LARS and Wexner scores)were recorded to evaluate anal function.Results 16 patients included in the study received operation successfully,with no conversions to open surgery.The median tumor distance from the anal verge was 3.0(2.0-3.5)cm.The mean operative time was(179.5±94.9)min,with a median blood loss of 33(10-100)mL.The anastomosis was 2.5(1.0-3.0)cm from the anal verge,and all surgical margins were negative.Two perioperative complications occurred:one case of postoperative hematochezia on day 9 requiring emergency interventional hemostasis,and one case of perianal abscess managed conservatively.The median time to stoma reversal was 7.5(3-13)months.With a median follow-up of 24 months,no local recurrence was observed.The mean LARS score at 2 years after stoma reversal was 13.5±4.2,and the mean Wexner score was 4.2±1.9,indicating good anal function.Conclusion Total laparoscopic ultra-low anterior resection with partial dentate line and full-thickness anal canal resection under everted vision is a feasible option for sphincter preservation in patients with extremely low rectal cancer,demonstrating favorable oncological outcomes and anal function.However,further studies are needed to evaluate its long-term efficacy and advantages over traditional techniques.
Keywords：rectal eversionintersphincteric resectionlow rectal cancerultra-low sphincter preservationanal function
Publication Date：2025-07-01
Online Publishing Date：2025-09-04(First online date of this platform, not the publication date of the document)
Pages：6( 806-811 )