scholarly journals Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

2020 ◽  
Vol 36 (3) ◽  
pp. 148-154 ◽  
Author(s):  
Osama Eldamshety ◽  
Sherif Kotb ◽  
Ashraf Khater ◽  
Waleed Elnahas ◽  
Sameh Roshdy ◽  
...  
Keyword(s):  
Total Mesorectal Excision ◽  
Anal Sphincter ◽  
Functional Outcomes ◽  
Sphincter Preservation ◽  
Single Group ◽  
Mesorectal Excision ◽  
Anal Function ◽  
Postoperative Assessment ◽  
Narcotic Analgesia ◽  
Normal Tone

Purpose: The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma.Methods: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year.Results: Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%).Conclusion: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.

Laparoscopic versus open total mesorectal excision with anal sphincter preservation for low rectal cancer

2004 ◽  
Vol 18 (8) ◽  
pp. 1211-1215 ◽  
Author(s):  
Z. -G. Zhou ◽  
M. Hu ◽  
Y. Li ◽  
W. -Z. Lei ◽  
Y. -Y. Yu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Sphincter ◽  
Sphincter Preservation ◽  
Low Rectal Cancer ◽  
Mesorectal Excision

scholarly journals Rise and fall of total mesorectal excision with lateral pelvic lymphadenectomy for rectal cancer: an updated systematic review and meta-analysis of 11,366 patients

2021 ◽  
Author(s):  
Gabriele Anania ◽  
Richard Justin Davies ◽  
Alberto Arezzo ◽  
Francesco Bagolini ◽  
Vito D’Andrea ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Neoadjuvant Therapy ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Mesorectal Excision ◽  
Timeline Analysis

Abstract The role of lateral lymph node dissection (LLND) during total mesorectal excision (TME) for rectal cancer is still controversial. Many reviews were published on prophylactic LLND in rectal cancer surgery, some biased by heterogeneity of overall associated treatments. The aim of this systematic review and meta-analysis is to perform a timeline analysis of different treatments associated to prophylactic LLND vs no-LLND during TME for rectal cancer. Methods A literature search was performed in PubMed, SCOPUS and WOS for publications up to 1 September 2020. We considered RCTs and CCTs comparing oncologic and functional outcomes of TME with or without LLND in patients with rectal cancer. Results Thirty-four included articles and 29 studies enrolled 11,606 patients. No difference in 5-year local recurrence (in every subgroup analysis including preoperative neoadjuvant chemoradiotherapy), 5-year distant and overall recurrence, 5-year overall survival and 5-year disease-free survival was found between LLND group and non LLND group. The analysis of post-operative functional outcomes reported hindered quality of life (urinary, evacuatory and sexual dysfunction) in LLND patients when compared to non LLND. Conclusion Our publication does not demonstrate that TME with LLND has any oncological advantage when compared to TME alone, showing that with the advent of neoadjuvant therapy, the advantage of LLND is lost. In this review, the most important bias is the heterogeneous characteristics of patients, cancer staging, different neoadjuvant therapy, different radiotherapy techniques and fractionation used in different studies. Higher rate of functional post-operative complications does not support routinely use of LLND.

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

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