Early and late clinico‐pathologic outcomes of minimally invasive total mesorectal excision for rectal cancer: A propensity score‐matched comparison of robotic and laparoscopic approaches

2021 ◽  
Author(s):  
Chan Hee Park ◽  
Sung Uk Bae ◽  
Woon Kyung Jeong ◽  
Seong Kyu Baek
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Matched Comparison

Surgical Treatment of Stage I Rectal Cancer

2020 ◽  
Author(s):  
Julio Garcia-Aguilar
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Local Excision ◽  
Neoadjuvant Chemoradiotherapy ◽  
Transanal Excision ◽  
Resection Margins ◽  
Rectal Tumors ◽  
Mesorectal Excision

For treatment of early-stage rectal cancer, local (transanal) excision offers the advantages of lower rates of morbidity, mortality, and functional impairment in comparison with radical surgery such as total mesorectal excision (TME). Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques. The main drawback of local excision is the higher risk of local recurrence compared with TME. The risk of local recurrence is higher in patients with close resection margins, tumors penetrating beyond the submucosa, or tumors with unfavorable histologic features. In these patients, outcomes for immediate proactive TME are generally better than observation followed by reactive salvage TME in case of local recurrence. The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors. As chemoradiation and local excision are being increasingly used for later-stage tumors, advances in imaging technologies will play a crucial role in facilitating careful patient selection.   This review contains 5 figures, 5 tables and 37 references Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery  

Surgical Treatment of Stage I Rectal Cancer

2020 ◽  
Author(s):  
Julio Garcia-Aguilar
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Local Excision ◽  
Neoadjuvant Chemoradiotherapy ◽  
Transanal Excision ◽  
Resection Margins ◽  
Rectal Tumors ◽  
Mesorectal Excision

For treatment of early-stage rectal cancer, local (transanal) excision offers the advantages of lower rates of morbidity, mortality, and functional impairment in comparison with radical surgery such as total mesorectal excision (TME). Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques. The main drawback of local excision is the higher risk of local recurrence compared with TME. The risk of local recurrence is higher in patients with close resection margins, tumors penetrating beyond the submucosa, or tumors with unfavorable histologic features. In these patients, outcomes for immediate proactive TME are generally better than observation followed by reactive salvage TME in case of local recurrence. The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors. As chemoradiation and local excision are being increasingly used for later-stage tumors, advances in imaging technologies will play a crucial role in facilitating careful patient selection.   This review contains 5 figures, 5 tables and 37 references Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery  

scholarly journals Update on Robotic Total Mesorectal Excision for Rectal Cancer

2021 ◽  
Vol 11 (9) ◽  
pp. 900
Author(s):  
Simona Giuratrabocchetta ◽  
Giampaolo Formisano ◽  
Adelona Salaj ◽  
Enrico Opocher ◽  
Luca Ferraro ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Indirect Costs ◽  
Population Based ◽  
Complication Rates ◽  
Mesorectal Excision ◽  
Invasive Treatment ◽  
Multicenter Studies

The minimally invasive treatment of rectal cancer with Total Mesorectal Excision is a complex and challenging procedure due to technical and anatomical issues which could impair postoperative, oncological and functional outcomes, especially in a defined subgroup of patients. The results from recent randomized controlled trials comparing laparoscopic versus open surgery are still conflicting and trans-anal bottom-up approaches have recently been developed. Robotic surgery represents the latest consistent innovation in the field of minimally invasive surgery that may potentially overcome the technical limitations of conventional laparoscopy thanks to an enhanced dexterity, especially in deep narrow operative fields such as the pelvis. Results from population-based multicenter studies have shown the potential advantages of robotic surgery when compared to its laparoscopic counterpart in terms of reduced conversions, complication rates and length of stay. Costs, often advocated as one of the main drawbacks of robotic surgery, should be thoroughly evaluated including both the direct and indirect costs, with the latter having the potential of counterbalancing the excess of expenditure directly related to the purchase and maintenance of robotic equipment. Further prospectively maintained or randomized data are still required to better delineate the advantages of the robotic platform, especially in the subset of most complex and technically challenging patients from both an anatomical and oncological standpoint.

scholarly journals Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases

2020 ◽  
Vol 11 (4) ◽  
pp. 653-661
Author(s):  
C. Ramachandra ◽  
Pavan Sugoor ◽  
Uday Karjol ◽  
Ravi Arjunan ◽  
Syed Altaf ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Da Vinci ◽  
Rectal Resection ◽  
Mesorectal Excision ◽  
Short Term ◽  
Oncological Outcomes ◽  
Duration Of Surgery

AbstractEmerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.

Sign in / Sign up

Export Citation Format

Share Document