The application of intraoperative strategies to reduce protective stoma in mid and low rectal cancer: a retrospective study utilizing indocyanine green and precise anatomical techniques

BACKGROUND: Mid and low rectal cancer is among the most prevalent malignancies worldwide. Total mesorectal excision (TME) remains the standard surgical approach for these cancers. However, anastomotic leakage (AL) represents a significant complication associated with laparoscopic total mesorectal excision (LaTME) in cases of mid-low rectal cancer, often necessitating the creation of a protective stoma. This study evaluates the "PHISTA Technique," a novel protocol that integrates perfusion assessment, splenic flexure mobilization, vascular optimization, and reinforced anastomosis, with the aim of reducing stoma rates while maintaining safety standards. METHODS: Patients diagnosed with mid and low rectal cancer between December 2022 and December 2024 were retrospectively included and categorized into the conventional LaTME group and the PHISTA Technique group. The basic characteristics and short-term outcomes of the two groups were compared. RESULTS: The protective stoma rate was 0% in the PHISTA group vs. 31.7% in the conventional LaTME group (P < 0.001). The AL rate was 5.7% (PHISTA) vs. 6.7% (conventional LaTME) (P > 0.05). There were no significant differences in operative time, blood loss, lymph node yield, or postoperative recovery indicators between the groups. CONCLUSION: The PHISTA Technique was associated with a significantly reduced rate of protective stoma without increasing the incidence of anastomotic leakage. This approach has the potential to reduce or eliminate the need for a subsequent stoma reversal surgery in a substantial proportion of patients, thereby potentially reducing patient suffering and economic burden.