Kết quả bước đầu phẫu thuật nội soi cắt trực tràng thấp với miệng nối đại tràng - hậu môn khâu tay qua đường hậu môn có bảo tồn cơ thắt trong ung thư trực tràng thấp

Objectives: To evaluate the applicability and early results of laparoscope - assisted anal sphincter - preserving operation with transanal intersphincteric resection, handsewn coloanal anastomosis, total mesorectal excision and preservation of the pelvic autonomic nerves for low rectal cancer. Material and method: Retrospective study. Between 09/2009 and 03/2011 at Binh Dan Hospital, the authors performed laparoscope - assisted transanal intersphincteric resection for 28 patients with low rectal cancer about 5cm from anal verge, with no sphincter involvement. Results: There was no surgical mortality. All of patients had safe margin. Patients felt less pain and had early bowel movement. Early complications were 17.9 percent (5/28 cases) include: 2 patients had anastomotic leak (7.1 percent), 1 patient had wound sepsis, 1 patient had incisional hernia and 1 patient had anastomotic stenosis 2 months later. Late complications: 4 cases (14.3 percent) had local relapse. There was 1 case with liver metastasis in 2 years follow-up (3.6 percent). In anorectal function: 26/28 patients (92.9 percent) defecated more than 3 times/day in 1 month follow-up. 6 months later, this rate decreased gradually to 57.1 percent (16/28). Conclusion: Laparoscope - assisted transanal intersphincteric resection with handsewn coloanal anastomosis for low rectal cancer is feasible and had showed the good results of oncology and preserves the anorectum if patients had been selected correctly. It prevents an abdominal incision for specimen extraction, so that patients have less pain, early recovery, otherwise it preserves sphincteric function. There will be a need for a larger scale study with longer followup time to further evaluate this procedure.