Transanal total mesorectal excision for low rectal cancer – first results
Authors:
V. Procházka 1; Z. Kala 1; M. Škrovina 2,3; T. Grolich 1; K. Klos 2
Authors‘ workplace:
primář: MUDr. M. Škrovina, Ph. D.
; Chirurgická klinika, FN Brno, přednosta: prof. MUDr. Z. Kala, CSc.
1; Chirurgické oddělení, Nemocnice Nový Jičín, a. s., Komplexní onkologické centrum Nový Jičín
2; I. chirurgická klinika, LF UP Olomouc, přednosta: prof. MUDr. Č. Neoral, CSc.
3
Published in:
Rozhl. Chir., 2015, roč. 94, č. 2, s. 64-68.
Category:
Original articles
Overview
Introduction:
First experiences with laparoscopic low anterior resection with transanal mesorectal excision in patients with low and mid rectal cancer are referred.
Methods:
During a 9 month period (between October 2013 and May 2014), 17 laparoscopically assisted rectal resections with transanal total mesorectal excision, hand-sewn colo-anal anastomosis and protective ileostomy were performed at two institutions (CHK FN Brno, CHO KOC Nový Jičín). There were 11 males and 6 females, with a mean age 68 years (range 49–81 years) in our cohort. The tumor was located 30–80mm from the anal verge (median 60 mm).
Results:
A negative distal resection margin was achieved in all patients. The circumferential resection margin was positive in two cases. The TME quality was described as complete in 8 cases and nearly complete in 9 cases. Mean operative time was 280 min (range 212–375 min) with no intra-operative complications. Anastomotic leakage was observed in two patients (12%). Median length of postoperative hospital stay was 9 days with a range of 6–30 days, in case of anastomotic and wound complications.
Conclusion:
According to our first experience we evaluated this method as feasible and safe with satisfactory pathological outcomes. We cannot recommend exact indications yet. It is assumed that the transanal approach for total mesorectal excision should be indicated in obese patients with a narrow pelvis and voluminous prostate.
Key words:
total mesorectal excision − transanal minimally invasive surgery
Sources
1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.
2. Nagtegaal ID, Velde CJH, Worp E, et al. Macroscopic evaluation of rectal cancer resection specimen: Clinical significance of the pathologist in quality Control. J Clin Oncol 2002;20:1729−34.
3. Atallah S., Perez BM, Albert M, et al. Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Techniques in Coloproctology 2013;17:321−5.
4. Wolthuis AM, Overstraeten AB, D’Hoore A. Transanal rectal excision: A pilot study. Dis Colon Rectum 2014;57:105–9.
5. Lacy AM, Rattner DW, Adelsdorfer C, et al. Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: „down-to-up“ total mesorectal excision (TME)--short-term outcomes in the first 20 cases. Surg Endosc 2013;27:3165−72.
6. Sylla P, Bordeianou LG, Berger D, et al. A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surgical Endoscopy 2013;27:3396−3405.
7. Velthuis S, Boezem PB, Peet DL, et al. Feasibility study of transanal total mesorectal excision. British Journal of Surgery 2013;100:828–31.
8. Dumont F, Goéré D, Honoré Ch, Elias D. Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 2012; 55:996–1001.
9. Martin ST, Heneghan HM Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. British Journal of Surgery 2012;99:603–12.
10. Willis S, Kasperk R, Braun J, et al. Comparison of colonic J-pouch reconstruction and straight coloanal anastomosis after intersphincteric rectal resection. Langenbeck’s Arch Surg 2001;386:193–9.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
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