Laparoscopic TME: Better Vision, Better Results?

AbstractThe curative treatment of locally advanced rectal cancer is currently based on chemoradiotherapy and total mesorectal excision (TME). Laparoscopy has developed considerably because of obvious clinical benefits such as reduced pain and shorter hospital stay. Recently, several prospective randomized clinical trials with long-term follow-up have showed that laparoscopy is noninferior to laparotomy with the same oncologic outcomes in terms of survival and local control rate. However, laparoscopic TME remains a challenging procedure requiring a high level of expertise and a long learning curve to ensure an adequate and safe resection. The only relative contraindication of laparoscopic rectal surgery is T4 rectal cancer extended beyond the plane of TME. In this situation, it is reasonable to consider an open resection to avoid an uncomplete resection. In obese and elderly patients, laparoscopic TME also provides the same benefits as in nonobese and younger patients but may be more difficult to achieve. This review summarizes current knowledge on the place of laparoscopic TME in the treatment of rectal cancer.

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Laparoscopic TME in rectal cancer – electronic supplementary: op-video

Langenbeck s Archives of Surgery ◽

10.1007/s00423-009-0556-y ◽

2010 ◽

Vol 395 (2) ◽

pp. 181-183 ◽

Cited By ~ 9

Author(s):

Alois Fürst ◽

Oliver Schwandner ◽

Arthur Heiligensetzer ◽

Igors Iesalnieks ◽

Ayman Agha

Keyword(s):

Rectal Cancer ◽

Laparoscopic Tme

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Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

Journal of Coloproctology ◽

10.1055/s-0041-1736640 ◽

2021 ◽

Vol 41 (04) ◽

pp. 411-418

Author(s):

María Labalde Martínez ◽

Alfredo Vivas Lopez ◽

Juan Ocaña Jimenez ◽

Cristina Nevado García ◽

Oscar García Villar ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Quality Indicators ◽

Resection Margin ◽

Surgical Techniques ◽

Transanal Total Mesorectal Excision ◽

Anal Margin ◽

Mesorectal Excision ◽

American Society ◽

Laparoscopic Tme

Abstract Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods A cohort prospective study with 50 (14 female and 36 male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the external anal margin) between the two groups. The rates of: postoperative morbidity (TaTME: 35%; LaTME: 30%; p = 0.763); mortality (0%); anastomotic leak (TaTME: 10%; LaTME: 13%; p = 0.722); wound infection (TaTME: 0%; LaTME: 3.3%; p = 0.409); reoperation (TaTME: 5%; LaTME: 6.6%; p = 0.808); and readmission (TaTME: 5%; LaTME: 0%; p = 0.400), as well as the length of the hospital stay (TaTME: 13.5 days; LaTME: 11 days; p = 0.538), were similar in both groups. There were no statistically significant differences in the rates of positive circumferential resection margin (TaTME: 5%; LaTME: 3.3%; p = 0.989) and positive distal resection margin (TaTME: 0%; LaTME: 3.3%; p = 0.400), the completeness of the TME (TaTME: 100%; LaTME: 100%), and the number of lymph nodes harvested (TaTME: 15; LaTME: 15.5; p = 0.882) between two groups. Conclusion Transanal total mesorectal excision is a safe and feasible surgical procedure for middle/lower-third rectal cancer.

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Predictors of Surgical Difficulty in Laparoscopic Total Mesorectal Excision

Polish Journal of Surgery ◽

10.5604/01.3001.0014.9721 ◽

2021 ◽

Vol 93 (6) ◽

pp. 33-39

Author(s):

Joseph C. Kong ◽

Swetha Prabhakaran ◽

Alison Fraser ◽

Satish Warrier ◽

Alexander G. Heriot

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Total Mesorectal Excision ◽

Univariate Analysis ◽

Open Approach ◽

Laparoscopic Total Mesorectal Excision ◽

Mesorectal Excision ◽

Nodal Stage ◽

Surgical Difficulty ◽

Laparoscopic Tme

Concerns have been raised regarding the oncological safety of laparoscopic total mesorectal excision (TME) as compared to an open approach. This study aimed to identify risk factors for surgically difficult laparoscopic TME. All consecutive laparoscopic rectal cancer cases were included from a prospectively maintained colorectal cancer database. The primary outcome was to identify risk factors for surgically difficult TME. A Surgical Difficulty Risk Score (SDRS) between 0 and 6 was calculated for each case with cases achieving an SDRS of 2 or greater being deemed as surgically difficult. A total of 2795 consecutive cases of laparoscopic TME were identified, with 464 (16.6%) surgically difficult cases. Univariate analysis found that operating in the male pelvis, performing abdomino-perineal resections, Hartmann’s procedures, and proctocolectomies were all significantly associated with higher operative difficulty (P < 0.001). A higher nodal stage of cancer (P = 0.046), and the resection of another organ (P = 0.003) were significantly associated with higher surgical difficulty. On multivariate analysis, a female pelvis was associated with a favorable laparoscopic resection (Odds ratio [OR] 0.54, 95% CI 0.43–0.67, P < 0.001), whereas patients who had another organ resection (OR 2.6, 95% CI 1.53–4.42, P < 0.001), nodal positivity (OR 1.37, 95% CI 1.11–1.69, P = 0.003), and high ASA scores had more difficult surgeries. Predictive factors for surgically difficult laparoscopic TME include male gender, high ASA scores, mid and low rectal cancer, positive nodal stage, and resection of another organ at time of surgery.

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