PATIENT CARE

Technological Advances Enable Highly Complex Laparoscopic Sphincter-Sparing Surgery

Englewood Hospital has a brand new operating room, where surgeons perform the most cutting edge operations, including sphincter-sparing surgery and transanal total mesorectal excision.
Englewood Hospital has a brand new operating room, where surgeons perform the most cutting edge operations, including sphincter-sparing surgery and transanal total mesorectal excision.

Thanks to technological advances, patients with colon cancer now can be presented with an alternative to life with a colostomy bag. Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons employ laparoscopic techniques that preserve the sphincter and maintain bowel continuity.

“Techniques like sphincter-sparing surgery have the same oncological results as an abdominoperineal resection, but they are technically challenging operations,” said Anna Serur, MD, chief of colon and rectal surgery at Englewood Hospital and Medical Center, who routinely performs the minimally invasive surgery.

Complicated surgeries that require experienced hands are regularly performed at Englewood Hospital. “We’ve assembled a team of regional experts to serve our community that equals the expertise of the leading cancer care centers in New York City,” said Michael T. Harris, MD, chief medical officer, and chief of surgery and surgical services, at Englewood Hospital. “We have the latest technology, the newest infusion center and the newest radiation oncology machines in facilities that are as good as any that you will find in New York. That technology makes our treatment more focused and with fewer side effects.”

Although nearly 40,000 cases of low-lying rectal cancer are diagnosed in the U.S. annually, not all patients qualify for the surgery. “A candidate for sphincter-sparing surgery must be younger, with a normal sphincter and have normal muscle tone in that region,” Dr. Serur said.

“But it’s quite something that a patient can leave the hospital on day 2, have most of their energy back by day 10 to 14 and return to preoperative bowel functioning in three months. That’s quite a different outcome than an open surgery and much different than needing a colostomy bag for the rest of your life.”

In addition to sphincter-sparing surgery, the colorectal team performs transanal total mesorectal excision (TaTME), a new and technically demanding technique that requires a surgeon to extract a cylindrical specimen of rectum and mesorectum through the anus as opposed to the abdomen. The procedure’s popularity is on the rise, as colorectal surgeons have observed positive oncological outcomes, reduced scarring and faster recovery.

“TaTME is a good technique to know, as it offers more options for the patient, but there’s not enough data on its outcomes to make it a gold standard,” Dr. Serur said.

Few colorectal surgeons specialize in such challenging operations, including through the anus instead of the abdomen, because the narrowness of the pelvis leaves little margin for error. The slightest misstep may cause irreparable nerve damage to the bowel or in sexual function.

Posted March 2017