Fluorescence-guided laparoscopic-assisted transabdominal intersphincteric resection for ultralow rectal cancer: report of a surgical technique

This paper describes a case in which fluorescence-guided laparoscopic-assisted transabdominal intersphincteric resection (ISR) was applied in a patient with ultralow rectal cancer. This study presented the successful dual-application of fluorescence technique. The patient was a 72-year-old male with a body mass index (BMI) of 22.6 kg/m². The lower edge of the rectal adenocarcinoma was 4 cm away from the anal verge. The clinical stage based on pelvic magnetic resonance imaging (MRI) was cT2N0M0. We performed fluorescence-guided and laparoscopic-assisted transabdominal ISR for the patient. About 24 hours before the operation, indocyanine green (ICG; 2.5 mg/mL) was injected into four sites of the submucosa layer around the tumor under colonoscopy for lymph node (LN) identification. ICG was also intravenously injected (2.5 mg/mL) during the operation to assess the real-time blood supply to the anastomosis. We achieved organ preservation via ISR. The LN dissection was thorough, and the mesorectum was complete. In the operation, we used fluorescence imaging to ensure no LNs remained. Moreover, real-time fluorescence imaging indicated satisfactory blood supply to the anastomosis. The duration of this operation was 215 min and the estimated blood loss was 20 mL. The patient was placed on a fluid diet 2 days after surgery and was discharged 7 days after surgery. No postoperative complications were observed. The number of LNs harvested was 18, and the pathological stage was T2N0M0. No adjuvant therapy was administered in this patient. In the latest follow-up, no recurrence was found, and the patient had comparable genitourinary function to that experienced pretreatment. Evidence from this case suggests that it is clinically safe and feasible to perform fluorescence-guided laparoscopic-assisted transabdominal ISR for ultralow rectal cancer.