Short-term outcomes of minimally invasive transanal total mesorectal excision for rectal cancer

Introduction: The aim of study was to evaluate the safety and feasibility of transanal total mesorectal excision (TaTME) for middle and low rectal cancer at Binh Dan Hospital. Patients and methods: Case series of all rectal cancer patients who underwent TaTME from January 2019 to July 2020 enrolled. Results: There were 21 patients (17 men and 4 women). The median age of patients was 58 years. The average surgical duration was 264 minutes [210 - 480]. The average blood loss was 168 ml [100 - 210]. The average hospitalization duration was 9.42 days [8 - 16]. There were 2 cases of complication as anastomotic leakage (9.5%) that responded well with conservative treatment. The ratio of R0 resection margin was 100%. There were two cases of positive postoperative circular resection margin (CRM) accounting for 9.5%. The average number of harvested lymph node were 12.34 [9 - 22]. Conclusions: TaTME could be performed safely with good oncological results for rectal cancer. This surgery has advantages for patients with narrow pelvis or obesity. Key word: Rectal cancer, laparoscopy, Transanal Total Mesorectal Excision (TaTME). Tóm tắt Đặt vấn đề: Mục tiêu của nghiên cứu nhằm khảo sát kết quả sớm của phẫu thuật nội soi (PTNS) cắt toàn bộ mạc treo trực tràng qua ngã hậu môn trong điều trị ung thư trực tràng (UTTT). Đối tượng và phương pháp nghiên cứu: Báo cáo loạt ca. Tất cả người bệnh (NB) UTTT được phẫu thuật bằng kỹ thuật cắt toàn bộ mạc treo trực tràng với PTNS qua ngã hậu môn từ tháng 1/2019 đến tháng 7/2020 tại Bệnh viện Bình Dân. Kết quả: Tổng số 21 Bệnh nhân (BN) (17 nam và 4 nữ) được thực hiện kỹ thuật này. Tuổi trung bình của BN là 58 tuổi. Thời gian phẫu thuật trung bình là 264 phút (210 - 480 phút). Lượng máu mất trung bình 168 ml (100 - 210 ml). Thời gian nằm viện trung bình là 9,42 ngày ( 8 - 16 ngày). Có 2 trường hợp xì miệng nối (9,5%) và được điều trị bảo tồn. Tỉ lệ bờ mặt cắt đạt được R0 là 100%. Có 2 trường hợp CRM (+) sau mổ (9,5%). Số lượng hạch nạo vét được trung bình là 12,34 hạch (9 - 22 hạch). Kết luận: PTNS cắt toàn bộ mạc treo trực tràng qua ngã hậu môn có thể thực hiện an toàn với kết quả tốt về mặt ung thư học. Phẫu thuật đặc biệt có lợi cho các BN có khung chậu hẹp hay béo phì. Từ khóa: Ung thư trực tràng, phẫu thuật nội soi, cắt toàn bộ mạc treo trực tràng ngã hậu môn.

CYTOLOGICAL DIAGNOSTICS OF INTRAOPERATIVE PERITONEAL WASHES IN GASTRIC CANCER

Diagnosis of peritoneal microcanceromatosis is the most important task allowing to determine treatment strategy for patients with stomach cancer. Laparoscopy combined with peritoneal flushing and subsequent cytological examination should be performed to detect the peritoneal microcanceromatosis at the preoperative stage. The objective of this work was to improve cytological diagnostics of peritoneal washings using immunocytochemical techniques and the cell block method. The work was carried out on the basis of 276 surgical peritoneal washings in patients with stomach cancer who were on treatment in the department of high-tech surgery of the Moscow Clinical Scientific Centre of the State Budgetary Healthcare Institution named after Loginov A.S. from June 2016 to June 2018. As a result, the optimal panel of monoclonal antibodies (Ber-EP4, CEA, CK20) was chosen, which increased the sensitivity from 52% to 96% and the specificity of cytological diagnosis from 80% to 98%, and the overall accuracy of the method from 67% to 98%.

Indications for Minimally Invasive Surgery for Ovarian Cancer

Epithelial ovarian cancer is often diagnosed in advanced stages and typically managed with surgical debulking followed by chemotherapy. For patients with presumed early-stage ovarian cancer, comprehensive surgical staging is essential for management, because 31% are upstaged. Over the past 15 years, minimally invasive techniques have improved and are increasingly being used to treat patients with ovarian cancer. Currently, only retrospective data support laparoscopic staging of patients with a suspicious adnexal mass or those surgically diagnosed with presumed early-stage ovarian cancer. Laparoscopy is also used in patients undergoing second-look procedures and to help evaluate whether patients should undergo optimal tumor debulking procedures or be initially managed with neoadjuvant chemotherapy. Randomized clinical studies are needed to further support the role of minimally invasive surgery in the treatment of ovarian cancer.