Clinical Experience and Analysis of Laparoscopic Total Mesorectal Excision Combined with Improved Bacon for the Treatment of Lower Rectal Cancer

This study is aimed at assessing the safety and feasibility of laparoscopic total mesorectal excision (LTME) combined with improved Bacon (IB) procedure in the treatment of lower rectal cancer. There were 347 patients undergoing sphincter-preserving operation at the authors hospital from 2003 to 2009. Of these, there were 201 cases with double stapler technique (DST) anastomosis in high-location group (range 6 to 12cm); 76 cases with DST anastomosis in low-location subgroup A (range 5 to 6cm); and 70 cases with IB anastomosis in low-location subgroup B (range 5 to 6cm). In high-location group vs. low-location subgroup A, anastomotic leak rate and covering stoma rate in low-location subgroup A were obviously higher (p=0.038 and p=0.040); in low-location subgroup A vs. low-location subgroup B, operative time in low-location subgroup B was a little longer (p=0.000). However, anastomotic leak rate and covering stoma rate were significantly higher in low-location subgroup A (p=0.043 and p=0.043). DST can be applied as the first choice if the inferior margin of tumor to anal verge is 6 to 12cm. For lower rectal cancer, 5 to 6cm from anal verge, when DST is not suitable for sphincter-preserving operation, IB anastomosis can be applied.