Feasibility and safety of proximal rectal pre-disconnection technique (PDT) combined with 3D laparoscopic camera inversion technique in intersphincteric resection for low rectal cancer.

A retrospective analysis was performed on the clinical data of 52 patients with low rectal cancer and a narrow pelvis treated between Mar. 2022 and Mar. 2025. Surgical outcomes (operation time, blood loss, protective stoma rate), postoperative complications (anastomotic leakage, anastomotic bleeding), postoperative recovery (time to first flatus, length of hospital stay), follow-up data, and pathological findings (circumferential resection margin, cytology of peritoneal lavage) were recorded and analyzed.

All patients successfully underwent laparoscopic ISR with anal sphincter preservation, with no intraoperative death or conversion to open surgery. The mean operation time was 169.0 ± 43.5 minutes, and mean intraoperative blood loss was 75.0 ± 37.7 mL. Two patients required a protective stoma. The overall postoperative complication rate was 1.9%, including one case of anastomotic leakage that required reoperation. The mean time to first flatus was 2.8 ± 0.9 days, and the mean length of hospital stay was 11.2 ± 4.3 days. After a median follow-up of 12 months, the 1-year overall survival rate and disease-free survival rate were both 100%, with a 100% sphincter preservation rate. Pathological examination confirmed negative proximal, distal, and pre-disconnection margins. The mean proximal margin was 11.0 ± 1.2 cm, and the distal margin was 1.5 ± 0.3 cm. Cytological and bacteriological examinations of peritoneal lavage fluid were negative.

Based on the analysis of 52 cases, the application of PDT combined with 3D laparoscopic camera inversion technique in ISR for low rectal cancer proves to be a safe and feasible approach. This technique demonstrates advantages of providing clear intraoperative visualization and facilitating surgical manipulation. While ensuring oncological radicality, it achieves satisfactory sphincter preservation with favorable short-term oncological outcomes. This technique represents a valuable and recommendable option for ISR procedures.