Минимально инвазивные реконструктивно-восстановительные технологии в хирургическом лечении больных дистальным раком прямой кишки

Arsen Osmanovich Rasulov; Iurii Mikhailovich Stoyko; Artur Eduardovich Kulikov; Jasur Makhirovich Madyarov; Zaur Rabadankadievich Rasulov; Andrey Vladimirovich Maksimenkov; Andrey Vladimirovich Botov; Sherif Alishikhovich Alishikhov; Ruslan Arsenovich Rasulov; Andrei Vasilyevich Vinogradov

doi:10.37469/0507-3758-2025-71-6-OF-2343

Vol. 71 No. 6 (2025), EXPERIENCE OF ONCOLOGY CLINICS

Vol. 71 No. 6 (2025)

Minimally Invasive Restorative Surgery for Low-Lying Rectal Carcinoma Patients

EXPERIENCE OF ONCOLOGY CLINICS

https://doi.org/10.37469/0507-3758-2025-71-6-OF-2343

Published 30.12.2025

Arsen Osmanovich Rasulov

Cancer center “Lapino” of the “Mother and Child” Group of companies

https://orcid.org/0000-0002-5565-615X

Iurii Mikhailovich Stoyko

Pirogov National Medical and Surgical Center

https://orcid.org/0000-0002-3394-5858

Artur Eduardovich Kulikov

Cancer center “Lapino” of the “Mother and Child” Group of companies

https://orcid.org/0000-0002-3024-9283

Jasur Makhirovich Madyarov

Cancer center “Lapino” of the “Mother and Child” Group of companies

https://orcid.org/0000-0001-9992-3822

Zaur Rabadankadievich Rasulov

Cancer center “Lapino” of the “Mother and Child” Group of companies

https://orcid.org/0000-0002-2306-407X

Andrey Vladimirovich Maksimenkov

Pirogov National Medical and Surgical Center

https://orcid.org/0000-0003-0139-3988

Andrey Vladimirovich Botov

Pirogov National Medical and Surgical Center

https://orcid.org/0000-0002-7946-7441

Sherif Alishikhovich Alishikhov

Tsentrosoyuz Hospital of the Russian Federation

https://orcid.org/0000-0003-0985-7126

Ruslan Arsenovich Rasulov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

https://orcid.org/0000-0002-7804-5335

Andrei Vasilyevich Vinogradov

Pirogov National Medical and Surgical Center

https://orcid.org/0009-0000-2328-9300

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pdf (Русский)

Keywords

distal rectal cancer
laparoscopic anterior resection
intersphincteric resection
intersphincteric resection
coloanal anastomosis
natural orifice specimen extraction

How to Cite

Rasulov , A. O., Stoyko , I. M., Kulikov , A. E., Madyarov , J. M., Rasulov , Z. R., Maksimenkov , A. V., Botov, A. V., Alishikhov, S. A., Rasulov , R. A., & Vinogradov, A. V. (2025). Minimally Invasive Restorative Surgery for Low-Lying Rectal Carcinoma Patients. Voprosy Onkologii, 71(6), OF–2343. https://doi.org/10.37469/0507-3758-2025-71-6-OF-2343

Abstract

Introduction. To preserve natural defecation and improve quality of life in patients with distal rectal cancer, sphincter-preserving techniques including low anterior resection (LAR) and intersphincteric resection (ISR) have been developed and implemented in surgical practice.

Aim. To evaluate short-term outcomes and demonstrate the feasibility of laparoscopic LAR/ISR with natural orifice specimen extraction (NOSE) and double-layer hand-sewn coloanal anastomosis without diverting stoma.

Materials and Methods. From February 2023 to March 2025, we retrospectively analyzed nine patients with distal rectal cancer (≤7 cm from anal verge) who underwent laparoscopic LAR/ISR with coloanal anastomosis without protective stoma.

Results. All 9 (100 %) patients underwent laparoscopic surgery. D2 lymph node dissection was performed in 2 (22.2%) patients, and D3 in 7 (77,8 %) of cases. Internal sphincter resection was performed in 5 (55,6 %) of cases. According to macroscopic assessment, median distal clearance was 2 cm (IQR 1-2.5 cm). Specimen extraction was transanal (NOSE) in 8 (88.9 %) patients and via minilaparotomy in 1 (11.1 %) of cases. All patients received double-layer hand-sewn coloanal anastomosis (end-to-end: 6 (66.7 %); side-to-end: 3 (33.3 %)).

Median operative time was 240 minutes (IQR 164-428), with median blood loss of 100 mL (IQR 50-200). Pathological assessment showed complete mesorectal excision (Quirke G3) in all in all 9 (100 %) cases with negative lateral, distal and proximal resection margins. Early postoperative complications (Clavien-Dindo I-II) occurred in 2 (22.2 %) patients. Median hospital stay was 8 days (IQR 7-12).

Conclusion. Laparoscopic LAR/ISR with NOSE and stoma-free coloanal anastomosis is safe and anatomically preserving. This approach is justified in selected, motivated patients without significant comorbidities who are committed to postoperative rehabilitation for functional recovery.

https://doi.org/10.37469/0507-3758-2025-71-6-OF-2343

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