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
Processing time: 66 Days and 20.1 Hours
ARTICLE HIGHLIGHTS
Research background

A vertical or horizontal incision in the lower abdomen about 5 cm long was utilized to extract the specimen, and then a circular incision about 4 cm in diameter was made in the right lower quadrant to complete the ileostomy for rectal cancer patients who accept prophylactic ileostomy. With ongoing developments in minimally invasive surgery, we tried an innovative method that involved surgical specimen extraction through a prophylactic ileostomy procedure so as to avoid making a vertical or horizontal incision in the lower abdomen. This procedure has not been reported in rectal cancer patients.

Research motivation

The purpose of this study was to compare and analyze the short and long-outcomes of surgical specimen extraction via a prophylactic ileostomy procedure vs a small lower abdominal incision procedure. The significance of this study is to inaugurate a more minimally invasive method for rectal cancer patients who accept prophylactic ileostomy.

Research objectives

The study aimed to evaluate the safety and feasibility of surgical specimen extraction via a prophylactic ileostomy procedure in patients with rectal cancer.

Research methods

Rectal cancer patients who accepted laparoscopic anterior resection and prophylactic ileostomy were systemically reviewed from June 2010 to October 2016 in our institution. Clinical characteristics, operative outcomes, pathological outcomes, postoperative complications, and follow-up information were collected and analyzed using SPSS version 21.0.

Research results

The results showed that mean operative time was significantly shorter in the experimental group compared to the control group (P = 0.001). Mean estimated blood loss was significantly less in the experimental group (P = 0.020). The pain reported by patients in the experimental group was significantly less than that of the controls during the first two days after surgery (P < 0.001 and P = 0.012, respectively). Postoperative complications did not increase. The estimated 5-year disease-free survival and overall survival rates were similar between the two groups (P = 0.671 and P = 0.645, respectively).

Research conclusions

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.

Research perspectives

In this study, we would like to emphasize that a single-use incision protector should be used to protect incision from pollution or cancer cell implantation when taking out the surgical specimen via the incision, and the ileostomy incision should not be too small so that the specimen is squeezed. This was a retrospective study, and bias may exist. We hope that further randomized prospective controlled trials will be conducted to confirm our results in the near future.