scholarly journals Coloplasty Neorectum versus Straight Anastomosis in Low Rectal Cancers

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Fazl Q. Parray ◽  
Javaid A. Magray ◽  
Manzoor Ahmad Dar ◽  
Nisar A. Chowdri ◽  
Rauf A. Wani ◽  
...  
Keyword(s):  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Anastomosis Group ◽  
Bladder Function ◽  
Random Allocation ◽  
Mesorectal Excision ◽  
Incontinence Score ◽  
Significant Difference ◽  
Carcinoma Rectum ◽  
Transverse Coloplasty

Introduction. Patients with the diagnosis of carcinoma rectum after random allocation were assigned to 2 groups. One group was subjected to total mesorectal excision with coloplasty neorectum reconstruction and another group to total mesorectal excision with straight anastomosis. This randomization was done by odds and even method by the sister in charge of the ward to avoid bias in randomization. The study included 42 patients with diagnosis of carcinoma rectum from 4 to 12 centimeters from anal verge. Composite incontinence score, bladder function, and sexual function were considered as the main outcome measures. Results. All patients of transverse coloplasty group had mild or moderate composite incontinence score while 7 (36.8%) patients of straight anastomosis group had a severe score at 7th POD (P<0.05). At 6 months, 100% patients in transverse coloplasty group had a nil score which was not achieved by any of the patients in the other group. An intragroup comparison showed an improvement in score with time in both groups more marked in transverse coloplasty group. Conclusion. Transverse coloplasty group showed a better QOL so far as anal incontinence is considered. However, no statistically significant difference was achieved when comparing bladder and sexual dysfunction between the two groups.

scholarly journals Comparison of short-term outcomes between Chinese surgical robot “Micro Hand S” assisted and laparoscopic total mesorectal excision for rectal cancer

2020 ◽  
Author(s):  
Yanlei Wang ◽  
Guohui Wang ◽  
Zheng Li ◽  
Ling Hao ◽  
Bo Yi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Functional Outcomes ◽  
Length Of Hospital Stay ◽  
Surgical Robot ◽  
Postoperative Outcomes ◽  
Large Sample Size ◽  
Mesorectal Excision ◽  
Robot Assisted ◽  
Significant Difference

Abstract Background As the first domestically produced Chinese surgical robot for clinical use, the Micro Hand S robot has been applied to total mesorectal excision (TME) for rectal cancer in our center since 2017. The aim of this study was to evaluate the safety and feasibility of the Micro Hand S robot-assisted TME (R-TME) in comparison with laparoscopic TME (L-TME).Methods Between May 2017 and February 2018, patients who underwent R-TME and L-TME in the Third Xiangya Hospital were prospectively included in this study. The data including intraoperative outcomes, postoperative outcomes, pathological outcomes, and functional outcomes were analyzed and compared.Results Totally, 30 patients underwent L-TME and 21 patients underwent R-TME. The patient characteristics of the two groups were similar. Regarding intraoperative and postoperative outcomes, the R-TME group had significantly less blood loss (95.2 vs. 130.0 ml, p = 0.022), shorter time to first flatus (2.1 vs. 2.9 d, p = 0.017) and first liquid intake (2.8 vs. 3.7 d, p = 0.027) than the L-TME group. There were no significant difference in the operative time, conversion, protective ileostomy, length of hospital stay, pain score, complications, and 30-day mortality between the two groups (p > 0.05). In addition, the pathological and functional outcomes also did not differ significantly.Conclusion The Micro Hand S robot-assisted total mesorectal excision is safe and feasible for rectal cancer. However, prospective and large sample size trials are needed to further confirm this conclusion.Trial registration:Clinicaltrial.gov, NCT02752698, Registered on 27 April 2016, https://clinicaltrials.gov/ct2/show/study/NCT02752698?term=Micro+hand&cntry=CN&draw=2&rank=1

Laparoscopic Total Mesorectal Excision for Ultralow Rectal Cancer with Transanal Intersphincteric Dissection as a First Step: A Single-surgeon Experience

2014 ◽  
Vol 80 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Riccardo Maglio ◽  
Massimo Meucci ◽  
Marco Gallinella Muzi ◽  
Marianna Maglio ◽  
Luigi Masoni
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Postoperative Mortality ◽  
Low Rectal Cancer ◽  
Rectal Disease ◽  
Mesorectal Excision ◽  
Estimated Blood Loss ◽  
Surgeon Experience

Laparoscopic intersphincteric resection (ISR) after neoadjuvant chemoradiation is helpful in the management of patients with low rectal cancer. With the advent of this technique, the need for performance of abdominoperineal resection seems to have decreased in patients with very low rectal tumors. The aim of the present study was to evaluate the feasibility of laparoscopic ISR preceded by transanal rectal dissection low rectal cancer. Between December 2009 and June 2011, we performed laparoscopic ISR for 30 patients with very low rectal cancer. Patients received preoperative concurrent chemoradiation (5 days a week for 5 weeks). The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, ISR, transanal coloanal anastomosis with coloplasty and loop ileostomy. Clinical data of 30 patients were analyzed retrospectively. Thirty patients (21 men, nine women) had a median age of 65 years (range, 37 to 75 years), a median body weight of 67 kg (range, 43 to 96 kg), and body mass index of 24 kg/m2 (range, 19 to 33 kg/m2). The distance of the tumor from the anal verge was 5 cm (range, 2 to 11 cm). The operative time was from 240 to 360 minutes, and estimated blood loss was 100 to 520 mL. There were no conversions and no postoperative mortality. This procedure is feasible and has favorable short-term results for radical treatment of very low rectal disease while preserving anal function.

scholarly journals COMPARATIVE ANALYSIS OF OPEN AND TRANSANAL TOTAL MESORECTAL EXCISION FOR RECTAL CANCER

2018 ◽  
pp. 67-73 ◽  
Author(s):  
Yu. A. Shelygin ◽  
S. V. Chernyshov ◽  
L. Yu. Kazieva ◽  
O. A. Maynovskaya ◽  
V. N. Kashnikov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Cancer Patients ◽  
Intraoperative Complications ◽  
Randomized Study ◽  
Operation Time ◽  
Invasive Technique ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Significant Difference

AIM: to evaluate results of transanal total mesorectal excision (TA TME) for rectal cancer. PATIENTS AND METHODS: Ninuty patients were included the prospective non-randomized study. Forty-five (50.0 %) of them underwent TA TME and 45 (50.0%) - conventional total mesorectal excision (TME). RESULTS: operation time was significantly higher in TA TME group: 276.4± 56.9 (190-400) minutes vs 188.0± 56.7 (100-310) minutes in open TME group (р=0.0001). The intraoperative complications rate was significantly higher in TA TME group: 7 (15.5 %) vs 1 (2.2 %) patient (р=0.05). No significant difference in postoperative morbidity was obtained: 18 (40.0%) in TA TME group vs 17 (37.7%) (р=1.0). Postoperative stay was lower in TATME group: 9 (7:14) vs 11 (10:14) days (р=0.04). Grade 2 specimen quality was detected significantly more often after TATME 26 (57.8 %) vs 15 (33.3 %) open TME (р=0.03), while Grade 3 specimens were more common after open procedure - 30 (66.7 %) vs 13 (28.9 %) TA TME group (р=0.0006). CONCLUSION: TA TME is a feasible procedure for rectal cancer patients. It demonstrated all benefits of minimally invasive technique, though learning curve is steep.

scholarly journals Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir

2013 ◽  
Vol 02 (04) ◽  
pp. 227-231 ◽  
Author(s):  
Shabeer Ahmed Mir ◽  
Nisar A. Chowdri ◽  
Fazl Q. Parray ◽  
Parvez Ahmed Mir ◽  
Yasir Bashir ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Current Treatment ◽  
Mesorectal Excision ◽  
Primary Rectal Cancer ◽  
Single Center Study ◽  
Sphincter Saving ◽  
Carcinoma Rectum ◽  
Specialized Unit

Abstract Summary and Background Data: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. Objectives: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. Materials and Methods: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. Results: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. Conclusion: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.

scholarly journals Comparison of short-term outcomes between Chinese surgical robot “Micro Hand S” assisted and laparoscopic total mesorectal excision for rectal cancer: a retrospective study

2020 ◽  
Author(s):  
Yanlei Wang ◽  
Guohui Wang ◽  
Zheng Li ◽  
Ling Hao ◽  
Bo Yi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Functional Outcomes ◽  
Surgical Robot ◽  
Postoperative Outcomes ◽  
Large Sample Size ◽  
Mesorectal Excision ◽  
Robot Assisted ◽  
Short Term ◽  
Significant Difference

Abstract Background As the first domestically produced Chinese surgical robot for clinical use, the Micro Hand S robot has been applied to total mesorectal excision (TME) for rectal cancer in our center since 2017. The aim of this study was to evaluate the safety and feasibility of the Micro Hand S robot-assisted TME (R-TME) in comparison with laparoscopic TME (L-TME).Methods Between May 2017 and February 2018, patients who underwent R-TME and L-TME in the Third Xiangya Hospital were included in this study. The data including intraoperative outcomes, postoperative outcomes, pathological outcomes, and functional outcomes were analyzed and compared. Results Totally, 30 patients underwent L-TME and 21 patients underwent R-TME. The patient characteristics of the two groups were similar. Regarding intraoperative and postoperative outcomes, the R-TME group had significantly less blood loss (95.2 vs. 130.0 ml, p = 0.022), shorter time to first flatus (2.1 vs. 2.9 d, p = 0.017) and first liquid intake (2.8 vs. 3.7 d, p = 0.027) than the L-TME group. There was no significant difference in the operative time, conversion, protective ileostomy, length of hospital stay, pain score, complications, and 30-day mortality between the two groups (p > 0.05). In addition, the pathological and functional outcomes also did not differ significantly.Conclusion The Micro Hand S robot-assisted total mesorectal excision is safe and feasible with short-term outcomes comparable to laparoscopic surgery. Prospective and large sample size trials are needed to further confirm this conclusion.

scholarly journals Local recurrence in patients treated for rectal cancer using total mesorectal excision or transection of mesorectum

2016 ◽  
Vol 73 (10) ◽  
pp. 927-933
Author(s):  
Bobana Milojkovic ◽  
Goran Stanojevic ◽  
Zoran Krivokapic ◽  
Nebojsa Ignjatovic ◽  
Marija Dimitrijevic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Total Mesorectal Excision ◽  
Total Mortality ◽  
Mesorectal Excision ◽  
Major Health Problem ◽  
Patients With Cancer ◽  
Clinical Center ◽  
Significant Difference ◽  
And Control

Background/Aim. Rectal cancer is a major health problem throughout the world, despite the great progress in the treatment and control of the disease. The aim of this study was to determine the effect of mesorectal excision type on local recurrence in patients operated on for rectal cancer within a 3- year period. Methods. The clinical retrospective study was conducted at the Clinic for General Surgery at the Clinical Center in Nis, Serbia, and included 225 patients with rectal cancer. Postoperatively, the patients were observed 36 months. Total mesorectal excision (TME) method was used in 129 (57.33%) patients, and partial mesorectal excision (PME) in 96 (42.66%). There were 145 (64.44%) man and 80 (35.55%) women, average age 66.8 years. Results. In 58 (25.77%) of the patients cancer was localized in the proximal third of the rectum, in 99 (44%) in the medium third, in 68 (30.22%) it was 8 cm of the anocutaneous line. In 167 (74.22%) patients rectal cancer was in T3 stadium. TME was performed in all the patients with cancer in the distal third of the rectum and in 61.61% of the patients with cancer in the medium third of the rectum. PME was performed in all the patients with localized cancer in the proximal third and in 38.38% of the patients with cancer in the medium third of the rectum. Local recurrence occurred in 20 (8.88%) patients, 12 (9.30%) in the TME group and 8 (8.33%) in the PME group, which was not a statistically significant difference. In 75% of the cases, relapse occurred in the patients in T3 stage. Relapse occurred in 55% of the cases in the second year after the surgery. The median survival of all the patients amounted to 35 months. The total mortality of all respondents in a 3-year period amounted to 5.3%. Conclusion. There were no statistically significant differences in the incidence of local recurrence and survival among patients who underwent TME and those underwent PME. The type of mesorectal excision does not affect the incidence of local recurrence in node-negative disease stages.

scholarly journals Transanal total mesorectal excision for rectal cancer: a multicentric cohort study

2019 ◽  
Vol 8 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Liang Kang ◽  
Yuan-Guang Chen ◽  
Hao Zhang ◽  
Hong-Yu Zhang ◽  
Guo-Le Lin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Survival Rates ◽  
Operating Time ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Kaplan Meier

Abstract Background Transanal total mesorectal excision (taTME) has recently emerged as a promising novel surgical procedure for rectal cancer. It is believed to hold the potential advantage of providing better access to mobilize the distal rectum and achieving better pathologic results. This study aimed to evaluate the feasibility of taTME for rectal cancer and summarize the preliminary experience in 10 Chinese hospitals. Methods A total of 211 patients were enrolled in this study. Variables for evaluation of safety, feasibility, and oncologic outcomes were retrospectively collected and analysed. Results The median distance between the tumor and the anal verge was 5.9 cm (range, 1.5–12 cm). The median operating time was 280 min (range, 70–600 min) and the median estimated intra-operative blood loss was 50 mL (range, 10–1,500 mL). The overall rate of complication was 27.9%. Among the 211 patients, 175 (82.9%) had complete TME and 33 (15.6%) had near complete TME. The circumferential resection margin was negative in 97.7% of patients. The patients were followed for a median of 35 months (range, 2–86 months). There was 7.6% (16) mortality, 6.2% (13) had local recurrence, and 12.8% (27) had systemic recurrence. Kaplan–Meier survival analysis showed that 1-, 2-, and 3-year disease-free survival rates were 94.8%, 89.3%, and 80.2%, respectively, and 1-, 2-, and 3-year OS rates were 97.4%, 95.7%, and 92.9%, respectively. Conclusions Although limited by its retrospective nature, taTME was safe and feasible in selected patients. Future work with rigorous data recording is warranted.

scholarly journals Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

2015 ◽  
Vol 28 (2) ◽  
pp. 117-120 ◽  
Author(s):  
Carlos Ramon Silveira MENDES ◽  
Marcus VALADÃO ◽  
Rodrigo ARAÚJO ◽  
Eduardo LINHARES ◽  
José Paulo JESUS
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Rectal Adenocarcinoma ◽  
Invasive Procedure ◽  
Oncological Outcome ◽  
Lower Rectal Cancer ◽  
Mesorectal Excision ◽  
Transanal Resection

RATIONAL: In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge. AIM: To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer. METHOD: The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM). RESULT: The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision). CONCLUSION: This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

scholarly journals Neoadjuvant (Chemo)radiotherapy With Total Mesorectal Excision Only Is Not Sufficient to Prevent Lateral Local Recurrence in Enlarged Nodes: Results of the Multicenter Lateral Node Study of Patients With Low cT3/4 Rectal Cancer

2019 ◽  
Vol 37 (1) ◽  
pp. 33-43 ◽  
Author(s):  
Atsushi Ogura ◽  
Tsuyoshi Konishi ◽  
Chris Cunningham ◽  
Julio Garcia-Aguilar ◽  
Henrik Iversen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Significant Proportion ◽  
Pooled Analysis ◽  
Resection Margins ◽  
Short Axis ◽  
Mesorectal Excision ◽  
Lateral Node

Purpose Improvements in magnetic resonance imaging (MRI), total mesorectal excision (TME) surgery, and the use of (chemo)radiotherapy ([C]RT) have improved local control of rectal cancer; however, we have been unable to eradicate local recurrence (LR). Even in the face of TME and negative resection margins (R0), a significant proportion of patients with enlarged lateral lymph nodes (LLNs) suffer from lateral LR (LLR). Japanese studies suggest that the addition of an LLN dissection (LLND) could reduce LLR. This multicenter pooled analysis aims to ascertain whether LLNs actually pose a problem and whether LLND results in fewer LLRs. Patients and Methods Data from 1,216 consecutive patients with cT3/T4 rectal cancers up to 8 cm from the anal verge who underwent surgery in a 5-year period were collected. LLND was performed in 142 patients (12%). MRIs were re-evaluated with a standardized protocol to assess LLN features. Results On pretreatment MRI, 703 patients (58%) had visible LLN, and 192 (16%) had a short axis of at least 7 mm. One hundred eight patients developed LR (5-year LR rate, 10.0%), of which 59 (54%) were LLRs (5-year LLR rate, 5.5%). After multivariable analyses, LLNs with a short axis of at least 7 mm resulted in a significantly higher risk of LLR (hazard ratio, 2.060; P = .045) compared with LLNs of less than 7 mm. In patients with LLNs at least 7 mm, (C)RT plus TME plus LLND resulted in a 5-year LLR of 5.7%, which was significantly lower than that in patients who underwent (C)RT plus TME (5-year LLR, 19.5%; P = .042). Conclusion LLR is still a significant problem after (C)RT plus TME in LLNs with a short axis at least 7 mm on pretreatment MRI. The addition of LLND results in a significantly lower LLR rate.

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