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

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.

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

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Văn Minh Tuấn Trần ◽  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Case Series ◽  
R0 Resection ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Hospital Patients ◽  
Surgical Duration ◽  
Cancer Laparoscopy

Abstract 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.

Our experience with transanal total mesorectal excision (TaTME) procedures in middle and distal rectal tumors

2020 ◽  
Vol 99 (3) ◽  
pp. 124-130
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Transanal Total Mesorectal Excision ◽  
Rectal Tumors ◽  
Mesorectal Excision ◽  
Permanent Colostomy ◽  
Conversion To Open Surgery ◽  
Distal Localization

Introduction: Transanal total mesorectal excision (TaTME) is a relatively new approach in surgical treatment of rectal cancer. There are no clear indications when to choose this strategy. It is a technically demanding procedure for the surgeon with a long learning curve, which should also be taken into account in evaluation of this method. The results of both oncological and postoperative complications must be properly evaluated to explore the benefit of TaTME. The aim of this study is to assess the potential benefit of TaTME compared to other alternatives in middle and distal rectal tumors. Methods: Retrospective evaluation of patients undergoing TaTME procedure performed by one team of surgeons between October 2014 and June 2019. The authors analyzed demographic indicators of the group of patients, tumor characteristics, specimen quality, early postoperative complications and the possibility of stoma reversal. Results: A total of 93 patients underwent TaTME procedure for middle and distal rectal cancer. Mean BMI was 27.6 (4.8). T3 or T4 tumor was found in 73 (78.5%) patients, 68 (73.1%) patients had positive lymph nodes and 12 (12.9%) patients were treated for synchronous metastatic rectal cancer. Neoadjuvant therapy was used in 80 (86%) patients. Conversion to open laparotomy was necessary in one case (1%). Stapled anastomosis was performed in 37 (39.7%) cases, handsewn in 56 (60.2%). A positive circumferential resection margin (CRM) was found in 10 (10.7%) cases. Distal resection margin (DRM) was positive in 3 (3.2%) patients. Pathological analysis showed a complete mesorectum in 18 patients (19.4%), nearly complete in 39 (41.9%) and an incomplete mesorectum in 36 (38.7%). Complications in the first 30 days after primary surgery were observed in 38 (40.8%) patients, mainly for anastomotic leak (19 patients, 20.4%). Reoperation was required in 7 (7.5%) patients. Permanent colostomy had to be performed in 4 (4.3%) cases. No patient died after surgery. Conclusion: In a selected group of patients it is possible to perform resection using this approach with acceptable postoperative morbidity and quality of the specimen. We used TaTME procedure in patients expected to have difficult TME due to obesity, size and distal localization of tumor. The incidence of conversion to open surgery was very low. Further studies for long term oncological outcomes are needed.

scholarly journals Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME

2018 ◽  
Vol Volume 10 ◽  
pp. 5239-5245 ◽  
Author(s):  
Mateusz Rubinkiewicz ◽  
Michał Nowakowski ◽  
Mateusz Wierdak ◽  
Magdalena Mizera ◽  
Marcin Dembiński ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Low Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Matched Study ◽  
Laparoscopic Tme

scholarly journals Transanal Total Mesorectal Excision (TaTME): Experience in Klaipėda University Hospital

2019 ◽  
Vol 18 (4) ◽  
pp. 235-238
Author(s):  
Vita Klimašauskienė ◽  
Narimantas Evaldas Samalavičius
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Cancer Treatment ◽  
Dentate Line ◽  
University Hospital ◽  
Lithotomy Position ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Rectal Cancer Treatment ◽  
Laparoscopic Tme

Introduction. Colorectal cancer ranks third on the list of the most common cancers. In 1979 R. J. Heald described total mesorectam excision (TME) which became a gold standard for rectal cancer treatment. This operation is performed all over the world open, laparoscopic and robotic. Operating on low and very low rectal cancer, distal bowel mobilisation if often the most difficult part of the operation. Aa a solution to this problem transanal abdominotransanal rectal resection (TATA) and transanal total mesorectal excision (TaTME) were proposed. This article reviews the experience and short-term postoperative outcomes of TaTME performed in Klaipėda University Hospital.Methods. The first stage of surgery was performed with patient placed in the prone jackknife (Kraske) position. Using electrocauthery circular mobilisation of the rectum was performed starting at least 1 cm from the lower edge of the tumour. Up to 10 cm of the rectum was mobilised from below. The second stage was performed with patient in lithotomy position. Laparoscopic TME was performed. For 11 (78.57%) patients hand sown anastomosis was performed and for 1 (7.17%) patient stapler was used. 2 (14.28%) patients underwent the Hartmann’s procedure.Results. In period 2018.03–2019.10 TaTME was performed for 14 patients. The medium tumour high counting from dentate line was 2.54 (±1.28). 13 out of 14 patients were operated from 8 to 12 weeks after chemoradiotherapy. All (100%) rectal resections were radical (R0). On average 11.43 (±3.78) lymphnodes were harvested. 5 (35.71%) patients had complications after surgery.Conclusions. TaTME performed at Klaipėda University Hospital is effective operation for rectal cancer treatment.

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