关键词: 经闭孔神经前入路, 低位直肠癌, 远端切缘, 二次离断, 近期疗效

Abstract: To evaluate the feasibility and short-term efficacy of secondary transection by trans-anterior obturator nerve gateway in the treatment of the failure of primary transection and the insufficiency of distal margin in low rectal cancer. Methods    The clinical data of 10 patients were retrospectively analyzed in the same surgical team of the Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, who used the anterior obturator nerve gateway to complete salvage treatment for the failure of primary resection of ultralow rectal cancer between September 2021 and August 2023. All patients underwent secondary transection by trans-anterior obturator nerve gateway, coloanal anastomosis or transabdominal intersphincteric resection, and routine ileostomy. Results    All 10 patients successfully received the secondary transection. Results of primary transection margin: frozen biopsy indicated positive margin in 3 cases and tumor adjacent to margin in 7 cases. Perioperative results: the median time for gateway establishment was 7 (5-10) minutes, the secondary transection height was 8.5 (7.0-11.0) mm, the final distal margin was 11.0 (8.0-14.0) mm, and the anastomosis was 2.0 (2.0-2.5) cm from the anal margin. The postoperative pathology of the secondary transection margin was negative. Postoperative complications (CD grade Ⅱ or above) were reported in 3 cases, including·2 cases of anastomotic leakage and 1 case of small-bowel obstruction, all of which were improved by conservative treatment. During a median follow-up time of 14 (8-24) months, 9 patients underwent stoma reversal, and 1 patient underwent permanent stoma because of anastomotic stenosis due to anastomotic leakage. No voiding dysfunction, local recurrence, or distant metastasis was observed in all patients. Conclusion    Secondary transection by trans-anterior obturator nerve gateway can be the salvage for the insufficiency of primary transection in low rectal cancer and provide the possibility of anal preservation again, but its long-term efficacy and advantages over traditional transanal transection need further research.

Key words: trans-anterior obturator nerve gateway, low rectal cancer, distal margin, secondary transection, short-term efficacy ,