Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 7, 2018; 24(1): 104-111
Published online Jan 7, 2018. doi: 10.3748/wjg.v24.i1.104
Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery
Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou
Peng Wang, Jian-Wei Liang, Hai-Tao Zhou, Zheng Wang, Zhi-Xiang Zhou, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Wang P and Liang JW contributed equally to this work; Wang P, Liang JW and Zhou ZX designed and performed the research; Zhou HT and Wang Z collected and analyzed the data; Wang P and Liang JW wrote the paper; Zhou ZX revised the paper.
Supported by the Capital Health Research and Development of Special, No. 2016-2-4022.
Institutional review board statement: The study was reviewed and approved by the ethics committee of National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhi-Xiang Zhou, MD, Professor, Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. zhouzx001@163.com
Telephone: +86-10-87787110 Fax: +86-10-87787110
Received: November 1, 2017
Peer-review started: November 2, 2017
First decision: November 14, 2017
Revised: November 22, 2017
Accepted: November 27, 2017
Article in press: November 27, 2017
Published online: January 7, 2018
Abstract
AIM

To retrospectively evaluate the safety and feasibility of surgical specimen extraction via a prophylactic ileostomy procedure in patient with rectal cancer.

METHODS

We systematically reviewed 331 consecutive patients who underwent laparoscopic anterior resection for rectal cancer and prophylactic ileostomy in our institution from June 2010 to October 2016, including 155 patients who underwent specimen extraction via a prophylactic ileostomy procedure (experimental group), and 176 patients who underwent specimen extraction via a small lower abdominal incision (control group). Clinical data were collected from both groups and statistically analyzed.

RESULTS

The two groups were matched in clinical characteristics and pathological outcomes. However, mean operative time was significantly shorter in the experimental group compared to the control group (161.3 ± 21.5 min vs 168.8 ± 20.5 min; P = 0.001). Mean estimated blood loss was significantly less in the experimental group (77.4 ± 30.7 mL vs 85.9 ± 35.5 mL; P = 0.020). The pain reported by patients during the first two days after surgery was significantly less in the experimental group than in the control group. No wound infections occurred in the experimental group, but 4.0% of the controls developed wound infections (P = 0.016). The estimated 5-year disease-free survival and overall survival rate were similar between the two groups.

CONCLUSION

Surgical specimen extraction via a prophylactic ileostomy procedure represents a secure and feasible approach to laparoscopic rectal cancer surgery, and embodies the principle of minimally invasive surgery.

Keywords: Minimally invasive surgery, Rectal cancer, Anastomotic leakage, Prophylactic ileostomy, Safety

Core tip: Prophylactic ileostomy plays an important role in reducing the incidence of anastomotic leakage in rectal cancer patients. In this paper, we introduce an innovative method named surgical specimen extraction via a prophylactic ileostomy procedure and to evaluate its safety and feasibility.