Preservation of left colic artery, suture reinforcement, and transanal tube (PST) technique with selective ileostomy to prevent anastomotic leakage in mid-low rectal cancer surgery
10.3760/cma.j.cn441530-20250331-00131
- VernacularTitle:术中保留左结肠动脉和加固缝合吻合口以及经肛放置减压管技术联合选择性末端回肠造口在中低位直肠癌前切除术后吻合口漏中的应用价值
- Author:
Xueyi ZHANG
1
;
Yangchao LU
;
Shizhao ZHOU
;
Xiaorui QIN
;
Wenju CHANG
Author Information
1. 复旦大学附属中山医院厦门医院普外科，厦门 361015
- Publication Type:Journal Article
- Keywords:
Laparoscopic low anterior resection;
Preservation of the left colic artery;
Reinforced suture of the anastomotic stoma;
Transanal placement of anal canal
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(11):1285-1290
- CountryChina
- Language:Chinese
-
Abstract:
Objective:This study evaluated the efficacy of the PST technique: Preservation of the left colic artery (P), suture reinforcement (S), and transanal tube (T) combined with selective fecal diversion via end ileostomy, in preventing anastomotic leakage following laparoscopic anterior resection (LAR) for mid-to-low rectal cancer.Methods:We retrospectively collected data for this descriptive case series from patients who underwent laparoscopic LAR with complete or partial application of the PST technique, some of whom received prophylactic ileostomy, at the Department of Colorectal Surgery, Zhongshan Hospital Affiliated to Fudan University, and its Xiamen Branch between July, 2022 and December, 2024. "Partial PST" was defined as the implementation of PS (Preservation of the left colic artery + suture reinforcement), PT (Preservation of the left colic artery + transanal tube), ST (suture reinforcement + transanal tube), or a single T procedure (Transanal tube). The primary outcome measures were the proportion of patients who received the PST technique and terminal ileostomy, as well as the incidence of anastomotic leaks.Results:Among 198 patients, 145 received complete PST. Fifty-three patients underwent partial PST (PT) because anastomotic reinforcement was not feasible due to an excessively low anastomosis or obesity. All patients achieved R0 resection. Postoperative pathology showed that 108 patients (54.5%) were at T3-T4 stage, and 81 patients (40.9%) had poorly differentiated adenocarcinoma or mucinous adenocarcinoma. A total of 19.7% (39/198) of patients developed grade II or higher postoperative complications, including 11 cases (5.6%) of surgical site infection and 7 cases (3.5%) of urinary retention. Five patients were rehospitalized within 30 days after surgery, among whom 2 had intestinal obstruction, and 3 developed grade C anastomotic leaks that required reoperation for salvage enterostomy. The overall incidence of anastomotic leakage was 3.0% (6/198). Fifty-three patients (26.8%) received protective ileostomy, with an anastomotic leak incidence of 1.9% (1/53). Methylene blue leakage occurred in 20 patients (10.1%), all of whom received prophylactic ileostomy and had no anastomotic leakage postoperatively. Among 61 patients who received neoadjuvant chemoradiotherapy before surgery, 28 underwent prophylactic ileostomy, and none developed anastomotic leaks after surgery.Conclusions:Routine application of the PST technique during laparoscopic low anterior resection, along with prophylactic enterostomy for ultra-high-risk populations, can effectively control the incidence of anastomotic leakage.
