Recently, Zhang Jianhua, vice president of the Third People's Hospital of Honghe Prefecture and Honghe Cancer Hospital, and Peng Youjun, deputy director of the Department of General Surgery, led a team to successfully carry out a difficult case of transsphincteric resection (ISR) for low-lying rectal cancer, which successfully achieved radical rectal cancer resection for patient Kong while saving the anus, avoiding permanent colostomy, and improving the quality of life of patients.
So, what is low-lying rectal cancer? Peng Youjun, deputy director of the Department of General Surgery and Gastrointestinal Surgery of the Third People's Hospital of Honghe Prefecture, introduced that the rectum length is 12~15 cm, which can be divided into three parts: upper, middle and lower. Therefore, low-lying rectal cancer is generally defined as rectal cancer that is < 5 cm from the margin or < 3 cm from the anorectal junction.
The difficult choice faced by patients with low-lying rectal cancer: preservation? Or save your life? Peng Youjun introduced that the traditional view of low-lying rectal cancer (the distance between the lower edge of the tumor and the anus is <5 cm) is that abdominal-perineal combined resection (APR) is the gold standard. The so-called APR surgery, in layman's terms, is to "dig out the anus", APR surgery brings serious urinary and sexual dysfunction to patients, and permanent stoma long-term care seriously affects the quality of life of patients. However, for low-lying rectal cancer, according to the traditional view, if APR surgery is not performed, radical resection of the tumor cannot be achieved, which increases the risk of tumor recurrence and metastasis after surgery.
Now, a new option for patients with low-lying rectal cancer - ISR (life-saving and-safe). ISR surgery refers to the removal of the rectal internal sphincter and the preservation of the anus of a new type of radical rectal resection ISR surgery unique, for some patients with low rectal cancer, if the tumor does not invade the external sphincter, or through neoadjuvant treatment of patients with obvious tumor retraction, we choose to operate transabdominally in strict accordance with TME surgery standards, transanal (remove the internal sphincter, retain the external sphincter), radically resect the tumor, and achieve the goal of ultra-low limit preservation.
It is understood that the patient Kong went to the Third People's Hospital of Honghe Prefecture and Honghe Prefecture Cancer Hospital for the first time not long ago. The diagnosis was: rectal adenocarcinoma cT4NxM0, rectal tumor 3cm away from the anus, after evaluation by the MDT team of the hospital, it was decided to undergo neoadjuvant therapy first. Subsequently, the patient received professional treatment from the radiation oncology team led by Director Wang Jiazhu, gave preoperative short-course radiotherapy, and was given neoadjuvant chemotherapy of the "Capox" program at the same time, and the tumor was reduced after the neoadjuvant treatment, and the opportunity to save the anus was won. Later, with the careful cooperation of the general and gastrointestinal surgery team led by Vice President Zhang Jianhua and Deputy Director Peng Youjun, and the anesthesiologist team in the operating room led by Director Hu Meizhong, "3D laparoscopic radical rectal resection (NOSES I D method ISR) + terminal ileal terminal prophylactic ostomy" was performed for the patient, which lasted for more than 4 hours, and finally successfully completed the ISR operation, realizing the patient's desire to preserve the anus and anus function at an ultra-low position.
Pu Wenjian Renyongping Wen Tu