Transanal minimally invasive rectal resection with total mesorectal excision after endoscopic mucosal resection

2017 ◽  
Vol 71 (3) ◽  
pp. 208-214
Author(s):  
Lumír Kunovský ◽  
Zdeněk Kala ◽  
Roman Svatoň ◽  
Milan Dastych ◽  
Radek Kroupa ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Endoscopic Mucosal Resection ◽  
Rectal Resection ◽  
Mesorectal Excision ◽  
Mucosal Resection

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.

scholarly journals Evolution of Transanal Total Mesorectal Excision

2020 ◽  
Vol 33 (03) ◽  
pp. 113-127
Author(s):  
Heather Carmichael ◽  
Patricia Sylla
Keyword(s):  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Surgical Techniques ◽  
Colorectal Disease ◽  
Surgical Approaches ◽  
Transanal Total Mesorectal Excision ◽  
Rectal Disease ◽  
Mesorectal Excision ◽  
Invasive Approach ◽  
Transanal Approach

AbstractMinimally invasive techniques continue to transform the field of colorectal surgery. Because traditional surgical approaches for rectal cancer are associated with significant mortality and morbidity, developing less invasive approaches to this disease is paramount. Natural orifice transluminal endoscopic surgery (NOTES), commonly known as “no incision surgery,” represents the ultimate minimally invasive approach to disease. Although transgastric and transvaginal approaches for NOTES surgery were the initially explored, a transrectal approach for colorectal disease is intuitive given that it makes use of the resected organ for transluminal access. Furthermore, the transanal approach allows for improved, precise visualization of the presacral mesorectal plane compared with an abdominal viewpoint, particularly in the narrow, male pelvis. Finally, experience with existing transanal platforms that have been used for decades for local excision of rectal disease made the development of a transanal approach to total mesorectal excision (TME) feasible. Here, we will review the evolution of minimally invasive and transanal surgical techniques that allowed for the development of transanal TME and its introduction into clinical practice.

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  

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