Small-Incision Rectal Cancer Procedure a 'Tristate First'

CINCINNATI—University of Cincinnati (UC) colorectal surgeons recently performed what is believed to be the Tristate's first minimally invasive (laparoscopic) procedure for advanced, difficult-to-treat cancers that develop very low in the rectum.

"Treatment options are very limited for people with advanced, low-lying rectal and anal cancers," says assistant professor Bradley Davis, MD. "By doing the procedure laparoscopically, we can minimize the patient's post-surgery pain, expedite recovery and improve cosmetic outcomes."

Known as laparoscopic abdominoperineal resection (APR), the procedure involves removing the cancerous tissue via an incision between the patient's legs, eliminating the need for a large incision into the abdomen. The procedure is used in special cases to treat advanced rectal cancers that affect the anal sphincter muscles, which control the release of bodily waste.

Davis and his colleagues are the only physicians in the Greater Cincinnati region specifically trained to perform this laparoscopic procedure.

To begin the APR, the surgeon makes a 1/3-inch cut near the navel and inserts the laparoscope, a flexible instrument tipped with a light source and camera that displays a clear image of the operative area on a monitor near the operating table. Other specialized surgical tools are inserted into the abdomen through four more tiny incisions (less than one centimeter each).

Then the surgeon cuts off about 15 inches of the lower large intestine—including the sigmoid colon, rectum and anus—and removes it from the abdomen via a small incision between the patient's legs.

Because the surgery requires removing both the rectum and the anal sphincter muscles, the patient must wear a permanent colostomy bag. This "pouch" is connected to the bowel and worn outside the body to collect waste that would normally pass through the digestive system.

"Although we can't eliminate the need for a permanent colostomy in patients with this type of advanced rectal cancer, we can offer them the best chance for eradicating the disease," adds Davis. "APR is very effective in curing this type of cancer, if detected early. The important thing is to perform a safe and effective procedure, but to do so using smaller incisions."

Davis and his colleagues are trained to research, diagnose and treat diseases of the colon and rectum. Together, they perform more than 100 laparoscopic colon and rectal procedures annually.

They see patients at Christ Hospital and the University Pointe Medical Campus. To schedule an appointment, call (513) 929-0104.