Laparoscopic Abdominoperineal Rectal Resection with Total Mesorectal Excision for a Large Ano-Rectal Tumor (with Drawings)

We present a demonstrative laparoscopic abdominoperineal resection with total mesorectal excision for a large ano-rectal tumor with side by side explicative drawings performed by Dr. Lucian Mocan at 3-rd Surgery Clinic (Clinica Chirurgie 3) Cluj Napoca, Romania. In addition an ovarian cysts was excised. A 58-year-old female patient had a chief complaint of changes in defecation habit combined with rectal bleeding for 6 months. No other diagnostic physical finding was detected except a mass above the dentate line in size revealed by digital rectal examination. Flexible colonoscopy showed a distal rectal tumor of 2-3 cm from the anal verge with 50% circumferential involvement and longitudinal extension up to 9 cm on middle rectum. Biopsy specimens of the tumor indicated a large (7/11 cm) anorectal adenocarcinoma with T4 extension and regional lymph node involvement as confirmed by CT scan, MRI and endoscopic ultrasound. In this context the patient received neo-adjuvant radiochemotherapy for 6 weeks. (conventional radiation of about 50 Gy with chemotherapy) Following neoadjuvant treatment, computed tomography (CT) and MRI scan of the abdomen and pelvis combined with intrarectal endoscopic ultrasound examination showed a shrinkage of the tumor (5/6 cm) We performed a laparoscopic abdominoperineal resection with total mesorectum excion for this patient in our department in a five port technique. The postoperative outcome was uneventful and the patient was discharged in the 5-th postoperative day.