b-Shaped Laparoscopic Dual Anastomosis for Mid-Low Rectal Cancer: A Safe and Feasible Technique

Aims: To assess the feasibility, safety, 1-year postoperative quality of life, and 2-year postoperative local recurrence of b-shaped laparoscopic dual anastomosis (bSLDA) technique in laparoscopic anterior resection (LAR) for mid-low rectal cancer. Methods: In this case-matched study, we retrospectively reviewed the database of 120 patients with mid-low rectal cancer who underwent LAR in Tangdu hospital between June 2014 and January 2017. The database included baseline characteristics, operative data and short-term outcomes, specimen, and pathological results. Among all the participants, 60 patients underwent bSLDA and 60 patients underwent conventional laparoscopic dual anastomosis (CLDA). After lymph node dissection and rectal dissociation, patients in the bSLDA group received the operation as follows: (1) the rectum distal end was closed vertically instead of horizontally; (2) the anastomosis was conducted in an end-lower corner of rectal stump. We also performed at least 2 years of follow-up (the median follow-up was 36 months, ranging from 24 to 54 months), including 2-year recurrence scores, 1-year low anterior resection syndrome (LARS) scores, and QLQ-C30 scores. Results: In this case-matched study, there were no differences between bSLDA group and CLDA group in operative data and short-term outcomes, which suggested that bSLDA and CLDA were equally safe. Furthermore, compared with CLDA group, bSLDA group had no statistical difference in the rate of anastomotic leakage (AL), but there was a trend that the rate in bSLDA was lower. In postoperative specimen data, the maximum and minimum edge distances of the ring from the rectal stump are longer in the bSLDA group. What is more, in the EORTC QLQ-C30 (version 3.0), the diarrhea score in bSLDA group was statistically lower (better) than in CLDA group (P = .043). Although bSLDA group had no significant differences in the LARS scores with CLDA group, there was a trend that the LARS scores were lower in bSLDA. At last, the 2-year local recurrence rate in both groups was not significantly different. Conclusions: The bSLDA technique is safe and accessible, which may reduce the incidence of AL to some extent. Therefore, it could be an alternative to laparoscopic proctectomy for mid-low rectal cancer and may also improve postoperative quality of life for many patients.