الفهرس 
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Abstract
This is a prospective single arm study conducted from January 2017 till
December 2019 at general Surgery Department, Sohag University hospital
and Colorectal Unit in Ain Shams University.Ethical approval was
obtained from the Local Ethics Committee.
Thirty five patients fulfilled our inclusion criteria were included in the
study after complete pre-operative thorough evaluation and they were
subjected to LTME.
Regarding sex incidence, there were 62.9% men and 37.1% women
with a sex ratio of 1.7:1. The mean age of the studied group was 54.4 years
±20.3.The mean body mass index was 23.89 (kg/m2). Associated
comorbidities were documented in 37.1% of patients.
As regard tumor site: middle third tumors were represented in
42.9 % of patients and lower third tumors were represented in 57.1 %
of studied group.
According to ASA stratification 62.8% of patients came in ASA
class I while 37.2% were ASA class II. Among all patients, twenty
three patients were defined as UICC stage II while twelve cancers were
stage III. Regarding tumor differentiation; 31.4% of tumors were well
differentiated, 51.4% moderately differentiated and 17.2% had poorly
differentiated tumors.
The mean operating time was 189 minutes (range140–280 minutes)
while the mean operative blood loss was 95.4 mL (range 75-120 mL).
Intra-operative complications occurred in three patients (8.5%); Intraoperative
bleeding occurred in one patient and bladder perforation
occurred in the second patient while ureteric injury occurred in the last
patient. The mean time to return of bowel function was 1.6 days while that
to resumption of oral feeding was 2.9 days. The mean postoperative
hospital stay was 6.77±1.7 days.
After statistical analysis of the factors which may influence the : -morbidity, pathological staging and ASA grade were significantly correlated with occurrence of complications. As regard functional outcome: 11.4% of patients had persistent erectile dysfunction, 42.8% of patients experienced six or fewer bowel movements per day. By the use of Kirwan scoring system, flatus (8.6%) while two patients (5.7 %) had incontinent to liquid stools and required pad use at night time – Two patients developed local recurrence (5.7%), two patients (5.7%) developed distant recurrence. The disease free survival rate at 36 months was 80.02 % with no significant difference between Stage II and stage III (p= 0.25). The overall 3-year survival rates were 88.6% with no significant difference between survival in the stage II and stage III groups. After comparing our results with results of both laparoscopic and open surgery from other authors and literature, w aparoscopic sphincter saving surgery for rectal cancer is technically feasible and a safe alternative to conventional open surgery with favourable short-term should be considered in all patients with a functioning sphincter mechanism and a rectal cancer more than 2 cm above the dentate line.