Laparoscopic Surgery for Lower Rectal Cancer with Functional Anal Preservation and Individualized Lateral Pelvic Lymph Node Dissection

（LLAR, the first in the world, 2000）

Since 2000, the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University, led by Professor Zhou Zongguang, has surmounted the blind zones and limitations of traditional rectal surgery by innovative laparoscopic approach, and performed laparoscopic anal preservation surgery for lower rectal cancer, as the first team worldwide. Professor Zhou and his colleagues also investigated the regional micrometastasis of rectal cancer, and redefined the surgical scope of dissection. They launched the first RCT in the field with several highlights:

• Surgical trauma was significantly reduced, much less blood loss (20~55ml), whereby blood transfusion is not needed in more than 90% of patients, 
• The rate of anal preservation surgery increased by 55%,
• Sexual, micturition, and defecation function improved by 25% after surgery, 
• local recurrence rate decreased by 23%, 
• five-year disease-free survival rate increased by 19%. 

Due to these achievements, the team was awarded the Second Prize of National Science and Technology Progress Award of China in 2006 and the Award of National Doctoral Dissertation of P.R. China in 2007. 

The results of the clinical research were cited in EAES (European Association for Endoscopic Surgery) clinical practice guidelines for laparoscopic rectal cancer surgery (2011), JSCCR (Japanese Society for Cancer of the Colon and Rectum) guideline for colorectal cancer treatment (2014), NCCN (National Comprehensive Cancer Network) practice guideline for rectal cancer treatment (2019). At present, the laparoscopic procedure for lower rectal cancer has been widely used in China as routine operations, benefiting tens of thousands of patients with rectal cancer.   

In recent years, the team initiated individualized laparoscopic lateral pelvic lymph node dissection for rectal cancer and drafted the first consensus for lateral dissection worldwide. Other innovative techniques of the team include functional extensive resection of local advanced rectal cancer, modified posterior resection of locally recurring cancer, laparoscopic extralevator abdominoperineal excision (ELAPE) without transposition, and small incision rectal cancer resection, etc. These techniques enable rectal cancer surgery to become more functional, minimally invasive, and bloodless and the clinical efficacy was significantly improved. The Department of Gastrointestinal Surgery maintained the highest operation volume of colorectal cancers in a single medical center worldwide, and kept the highest excellent reviews from different third international party (Mayo Clin & Mayo Fdn, United States, and HELIOS Klinikum Berlin, Germany) in overall outcome indicators including complication, five-year survival and local recurrence rate.

However, for many years, this most valuable surgical procedure in West China Hospital brought the lowest economic burden to the patients with rectal cancer, so its price was called as "cabbage price" and well received by the patients.