Minimally Invasive Restorative Surgery for Low-Lying Rectal Carcinoma Patients

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Abstract

Introduction. To preserve natural defecation and improve quality of life in patients with distal rectal cancer, sphincter-preserving techniques including low anterior resection (LAR) and intersphincteric resection (ISR) have been developed and implemented in surgical practice. Aim. To evaluate short-term outcomes and demonstrate the feasibility of laparoscopic LAR/ISR with natural orifice specimen extraction (NOSE) and double-layer hand-sewn coloanal anastomosis without diverting stoma. Materials and Methods. From February 2023 to March 2025, weretrospectively analyzed nine patients with distal rectal cancer (≤ 7 cmfrom anal verge) who underwent laparoscopic LAR/ISR with coloanal anastomosis without protective stoma. Results. All 9 (100 %) patients underwent laparoscopic surgery. D2 lymph node dissection was performed in 2 (22.2%) patients, and D3 in 7 (77,8 %) of cases. Internal sphincter resection was performed in 5 (55,6 %) of cases. According to macroscopic assessment, median distal clearance was 2 cm (IQR 1-2.5 cm). Specimen extraction was transanal (NOSE) in 8 (88.9 %) patients and via minilaparotomy in 1 (11.1 %) of cases. All patients received double-layer hand-sewn coloanal anastomosis (end-to-end: 6 (66.7 %); side-to-end: 3 (33.3 %)). Median operative time was 240 minutes (IQR 164-428), with median blood loss of 100 mL (IQR 50-200). Pathological assessment showed complete mesorectal excision (Quirke G3) in all in all 9 (100 %) cases with negative lateral, distal and proximal resection margins. Early postoperative complications (Clavien-Dindo I-II) occurred in 2 (22.2 %) patients. Median hospital stay was 8 days (IQR 7-12). Conclusion. Laparoscopic LAR/ISR with NOSE and stoma-free coloanal anastomosis is safe and anatomically preserving. This approach is justified in selected, motivated patients without significant comorbidities who are committed to postoperative rehabilitation for functional recovery.

About the authors

A. O. Rasulov

Cancer center “Lapino” of the “Mother and Child” Group of companies

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-5565-615X
SPIN-code: 8416-1162
ResearcherId: MIT-0243-2025
Moscow region, the Russian Federation

Iu. M. Stoyko

Pirogov National Medical and Surgical Center

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-3394-5858
SPIN-code: 8835-0076
ResearcherId: P-4518-2016
Moscow, the Russian Federation

A. E. Kulikov

Cancer center “Lapino” of the “Mother and Child” Group of companies

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-3024-9283
SPIN-code: 1786-6281
ResearcherId: MIQ-9223-2025
Moscow region, the Russian Federation

J. M. Madyarov

Cancer center “Lapino” of the “Mother and Child” Group of companies

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0001-9992-3822
SPIN-code: 9334-8284
ResearcherId: MIQ-9472-2025
Moscow region, the Russian Federation

Z. R. Rasulov

Cancer center “Lapino” of the “Mother and Child” Group of companies

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-2306-407X
SPIN-code: 4723-9010
ResearcherId: MIQ-8985-2025
Moscow region, the Russian Federation

A. V. Maksimenkov

Pirogov National Medical and Surgical Center

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0003-0139-3988
SPIN-code: 1559-1172
ResearcherId: MJS-6250-2025
Moscow, the Russian Federation

A. V. Botov

Pirogov National Medical and Surgical Center

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-7946-7441
SPIN-code: 5707-6742
ResearcherId: MJL-9960-2025
Moscow, the Russian Federation

S. A. Alishikhov

Tsentrosoyuz Hospital of the Russian Federation

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0003-0985-7126
SPIN-code: 3382-8043
ResearcherId: MIT-0005-2025
Moscow, the Russian Federation

R. A. Rasulov

I.M. Sechenov First Moscow State Medical University

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0000-0002-7804-5335
SPIN-code: 5479-3332
ResearcherId: MIT-0262-2025
I.M. Sechenov First Moscow State Medical University, Moscow, the Russian Federation

A. V. Vinogradov

Pirogov National Medical and Surgical Center

Email: kulikov_a.e_md@mail.ru
ORCID iD: 0009-0000-2328-9300
SPIN-code: 5708-1978
ResearcherId: MIT-5613-2025
Moscow, the Russian Federation

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