Clinical application of laparoscopic total mesorectal excision using the intersphincteric approach through the sacrococcygeal incision for treating patients with rectal cancer

Introduction
Colorectal cancer is the third most common cancer causing death in Western countries; laparoscopic surgery for colorectal cancer has many advantages and thus has been used widely. Laparoscopic total mesorectal excision through the sacrococcygeal incision under direct visualization to excise distal rectal cancer is an important procedure for super-low rectal carcinomas.

Aim
To investigate the feasibility of mesorectal excision and super-low rectal carcinoma excision using the intersphincteric approach through the sacrococcygeal incision.

Material and methods
From December 2009 to June 2017, intersphincteric resection was performed through the sacrococcygeal incision; the mesentery was excised in 27 patients with rectal cancer and a contracted pelvis (the lower edge of the tumor was 4 to 7 cm to the anal verge) through laparoscopy in the Gastrointestinal Surgery Department of our hospital.

Results
No death was recorded during surgery. The surgical time ranged from 190 to 310 min, the bleeding volume was 50 to 150 ml, and the post-surgical length of stay was 6 to 19 days. There were three cases of anastomotic fistulas, one case of anastomotic stenosis, and one case of fecal incontinence. Follow-up visits were scheduled for 19 patients, with a mean time of 37 months, ranging from 3 to 92 months; one case of local recurrence, one case of peritoneal metastasis, and two cases of hepatic metastasis were observed.

Conclusions
Laparoscopic total mesorectal excision using the intersphincteric approach through the sacrococcygeal incision is feasible for treating patients with a contracted pelvis and super-low rectal carcinoma.