V3 Laparoscopic abdomino‐sacral composite resection for rectal cancer

Introduction:  Locally advanced rectal cancer with posterior fixity is a difficult oncological problem. Abdomino‐sacral composite resection is a procedure that benefits a select group of patients whose preoperative imaging confirms the absence of distant metastases and the possibility of an R0 resection, despite sacral invasion. Our video describes the technique of laparoscopic abdomino‐sacral composite resection. Method and outcome:  A 55‐year‐old male with low rectal cancer presented with large bowel obstruction for which he had a diverting loop ileostomy. Subsequent staging investigations, including MR of the rectum and CT of the chest, abdomen and pelvis, confirmed a rectal cancer at 5 cm from the anal verge with no metastatic disease. The tumour extended posteriorly and involved the margin of the S5 vertebra. The patient received neoadjuvant long course chemoradiotherapy. The video demonstrates laparoscopic mobilisation of the left hemicolon, TME and vascular pedicle ligation. The patient was then turned into the prone jack‐knife position. The video shows sacrectomy at the S3/4 junction, aperture completion of the rectal dissection and specimen retrieval. A composite mesh was used to close the sacral aperture. Discussion:  We have found this combined technique to be both feasible and safe for the management of posteriorly advanced rectal tumours with sacral extension.