Fortunately, the tumor was found early and could be treated radically through surgery. However, the problem is that the lower edge of the tumor is only 3cm away from the anus, so it is possible that the anus cannot be preserved by traditional surgery, and an “artificial anus” will be needed, and he will have to defecate through the colostomy in the left lower abdomen for life, which will be very inconvenient. I. What cases of rectal cancer can be preserved? For rectal cancer treatment, radical surgical resection is the most effective and the only curable treatment method among all treatments. Among them, most of the patients with low and middle rectal cancer face the problem of whether the original anus can be preserved, so-called “anal preservation surgery”, and the lesion can be completely removed. Anal preservation surgery for low and middle rectal cancer depends on the following two points: first, whether to preserve the anus, and second, whether the anus can be preserved. Whether to preserve anus or not mainly
It depends on the location of the tumor, the size of the tumor itself, the depth of invasion and the function of the patient’s anus. Usually, in order to remove the tumor completely, it is required to remove about 2cm of normal tissues distal to the tumor. If the tumor is located too low and close to the internal opening of the anus, the lack of distal resection will lead to the residual and recurrence of the tumor. Once local recurrence occurs, the chance of radical surgery is very small and the patient will suffer a lot. If the tumor is large and already locally advanced, more surrounding and distal tissues will need to be removed and the location of the tumor will be more demanding. In addition, another issue in whether to preserve the anus or not is that if the patient already has anal flaccidity and partial fecal incontinence before the surgery, the ultra-low anal preservation surgery needs to be especially cautious. If the anus is barely preserved and the patient develops severe fecal incontinence after surgery, the quality of life is far less than that of a colostomy. On the issue of being able to preserve the anus, it mainly depends on the patient’s physical condition. For example, although the tumor is relatively early and the location of the tumor is relatively high, the patient is male and very obese. As a result, the space in the pelvic cavity will be very small and the surgery will be very difficult. After the lesion is removed, it will be more difficult to perform reconstruction and it may be difficult to perform anal preservation. Another very important factor is the experience and skill of the surgeon. Some studies have shown that the rate of anal preservation for low to medium rectal cancer surgery is much higher for anorectal surgeons than for general surgeons, and the local recurrence rate is much lower. One of the reasons is that anorectal surgeons, as specialists, have done more rectal surgery and have more experience in rectal surgery, so it is recommended to ask specialists to perform surgery for rectal cancer, especially low and middle rectal cancer. 3D laparoscopy: 85% of patients with low rectal cancer can achieve precise anus preservation Traditional rectal cancer surgery is performed by open incision, which is about 20cm long from top to bottom of the abdomen, exposing the whole abdominal cavity to the air, resulting in great trauma and bleeding. Postoperatively, patients need to be bedridden for 4-5 days due to painful incision, and complications such as infection and cracking of the incision often occur. Super low rectal cancer, due to its deep location, makes it difficult for the surgeon to see the structures located deep in the pelvis, making the operation very difficult, with a high complication rate and a low anal preservation rate. In the last 10 years or so, laparoscopic surgery has been widely used in clinical practice, which can significantly reduce the trauma caused by the surgery, and only requires a 5-6 cm incision in the abdomen to remove the resected specimen from the body and anastomose the distal and proximal intestines. After the surgery, the patient’s abdominal pain, incisional infection and other complications are significantly reduced, which is the so-called “minimally invasive surgery”. However, traditional laparoscopic surgery uses 2D laparoscopic equipment, and the surgeon sees 2D flat images without a sense of depth, as if the surgeon is operating with one eye open, without a precise three-dimensional sense, with a poor grasp of space, difficult to review the operation and long operation time. In recent years, with the development of laparoscopic technology, stereoscopic 3D laparoscopy began to be used in clinical surgery, and by wearing special glasses, the surgeon sees
By wearing special glasses, the surgeon sees a three-dimensional image, which enables the surgeon to grasp the depth of the instrument more precisely and to see an image 8 times larger than the real surgical field of view.
It allows the surgeon to see an image eight times larger than the real surgical field of view, and the hair-thin nerve fibers and capillaries are also visible. As a result, the surgical field of view is much better than traditional open and 2D laparoscopic surgery
It is possible to achieve very precise separation and dissection, and the whole operation can be basically non-bleeding, white bloodless, and extremely minimally invasive. Meanwhile, in a large number of 3D
laparoscopic colorectal surgery, we are the first in the world to perform a variety of surgeries to remove the resected specimen through the distal intestinal cavity and perform intestinal reconstruction at the same time, which is called “incisionless abdominal colorectal surgery with removal of the specimen through the natural cavity”. Although the patient undergoes a large surgical resection in the abdominal cavity, including partial or complete resection of the colon for rectal cancer, sigmoid colon cancer, chronic constipation, familial polyposis, etc., all operations are performed in the closed abdominal cavity without exposure to air because there is no incision in the abdomen, and there are only a few puncture holes in the abdomen for the whole operation, so there is little interference with the organs in the abdominal cavity, and bowel function is quickly restored after the operation. The intestinal function recovered quickly after the operation, and complications such as incisional pain and infection were fundamentally avoided. At the same time, since there is no blood loss during the operation, even a gastric tube is not needed, and even an elderly person over 90 years old
Even 90-year-old people can go to the floor the day after the surgery, which can effectively avoid postoperative pain, bed rest, and various complications caused by gastric tube placement, etc. In addition, since 3D laparoscopy has 8 times magnified field of view and three-dimensional sensation, the operation is more accurate and convenient than open and traditional laparoscopy, and it can achieve more complete resection of low and ultra-low rectal cancer and better protection of nerves and muscles that control defecation, so that rectal cancer that is about 2 cm away from the anus can be removed.
At the same time, the nerves and muscles controlling defecation are better protected, so that rectal cancer around 2 cm away from the anus can also become the scope of anal preservation surgery, thus enabling 85% of rectal cancer patients today to achieve the ultimate minimally invasive anal preservation surgery.