Beyond transanal total mesorectal excision: short‐term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision

2020 ◽  
Author(s):  
José Tomás Larach ◽  
Amrish K. S. Rajkomar ◽  
Philip J. Smart ◽  
Jacob J. McCormick ◽  
Alexander G. Heriot ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Short Term

Locally Advanced Rectal Cancer

2020 ◽  
Author(s):  
David A Kleiman ◽  
Martin R. Weiser
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Nonoperative Management ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Total Neoadjuvant Therapy

Locally advanced rectal cancer is a complex disease that requires a multidisciplinary treatment team to carefully evaluate each patient before prescribing a treatment plan. The current standard of care in the United States is multimodal therapy, consisting of chemotherapy, radiation, and surgery. Commonly, this involves neoadjuvant long-course chemoradiation, followed by total mesorectal excision and then adjuvant systemic chemotherapy. However, alternative regimens using chemotherapy first, followed by chemoradiation and then surgery (total neoadjuvant therapy), may allow for better tolerance of therapy. Short-course radiation is also acceptable but is rarely used in the United States. Minimally invasive surgical techniques such as laparoscopy, robotic surgery, and transanal total mesorectal excision offer several potential advantages over conventional open surgery, but their oncologic equivalence has not been determined. The role of nonoperative management for locally advanced rectal cancer is still evolving, and additional studies are needed to improve patient selection and evaluate long-term outcomes of a watch-and-wait approach.  This review contains 1 figure, 2 table and 58 references Key words: colorectal cancer, locally advanced rectal cancer, minimally invasive surgery, nonoperative management, radical proctectomy, robotic surgery, total mesorectal excision, total neoadjuvant therapy, transanal total mesorectal excision, watch and wait

Locally Advanced Rectal Cancer

2020 ◽  
Author(s):  
David A Kleiman ◽  
Martin R. Weiser
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Nonoperative Management ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Total Neoadjuvant Therapy

Locally advanced rectal cancer is a complex disease that requires a multidisciplinary treatment team to carefully evaluate each patient before prescribing a treatment plan. The current standard of care in the United States is multimodal therapy, consisting of chemotherapy, radiation, and surgery. Commonly, this involves neoadjuvant long-course chemoradiation, followed by total mesorectal excision and then adjuvant systemic chemotherapy. However, alternative regimens using chemotherapy first, followed by chemoradiation and then surgery (total neoadjuvant therapy), may allow for better tolerance of therapy. Short-course radiation is also acceptable but is rarely used in the United States. Minimally invasive surgical techniques such as laparoscopy, robotic surgery, and transanal total mesorectal excision offer several potential advantages over conventional open surgery, but their oncologic equivalence has not been determined. The role of nonoperative management for locally advanced rectal cancer is still evolving, and additional studies are needed to improve patient selection and evaluate long-term outcomes of a watch-and-wait approach.  This review contains 1 figure, 2 table and 58 references Key words: colorectal cancer, locally advanced rectal cancer, minimally invasive surgery, nonoperative management, radical proctectomy, robotic surgery, total mesorectal excision, total neoadjuvant therapy, transanal total mesorectal excision, watch and wait

scholarly journals Transanal Total Mesorectal Excision: Description of the Technique

2020 ◽  
Vol 33 (03) ◽  
pp. 144-149
Author(s):  
Jean-Sébastien Trépanier ◽  
F. Borja de Lacy ◽  
Antonio M. Lacy
Keyword(s):  
Total Mesorectal Excision ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Transanal Surgery ◽  
Rectal Tumors ◽  
Mesorectal Excision ◽  
Short Term ◽  
Optimal Outcomes

AbstractSurgery remains the gold standard for the treatment of locally advanced rectal cancer. The most effective approach to reduce locoregional recurrence is total mesorectal excision (TME). However, obtaining an optimal TME is demanding, especially in low rectal tumors and anatomically unfavorable pelvis. Transanal TME (taTME) was developed to facilitate low pelvis dissection and potentially provide optimal outcomes for oncologic resection.Current studies have reported satisfactory short-term outcomes. However, taTME is a technically challenging procedure and must be learned in an appropriate training process to allow for a safe implementation. Previous experience in laparoscopic and transanal surgery is strongly recommended. In this work, we provide a detailed discussion of the technique, based on the realization of more than 400 taTME interventions.

Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer

2021 ◽  
Author(s):  
Narendra Pandit ◽  
Kunal Bikram Deo ◽  
Sujan Gautam ◽  
Tek Narayan Yadav ◽  
Awaj Kafle ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Mesorectal Excision

scholarly journals Impact of Body Mass Index on Surgical and Oncological Outcomes in Laparoscopic Total Mesorectal Excision for Locally Advanced Rectal Cancer after Neoadjuvant 5-Fluorouracil-Based Chemoradiotherapy

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Yanwu Sun ◽  
Pan Chi
Keyword(s):  
Body Mass Index ◽  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Locally Advanced ◽  
Oncological Outcome ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Laparoscopic Total Mesorectal Excision ◽  
Mesorectal Excision

Aims.To evaluate the impact of body mass index (BMI) on the surgical outcome of laparoscopic total mesorectal excision (laTME) for locally advanced rectal cancer (LARC, clinically staged as UICC stage II/III) after neoadjuvant chemoradiotherapy (nCRT).Methods.312 LARC patients undergoing laTME after nCRT were divided into nonobese (BMI < 25.0 kg/m2,n=249) and obese (BMI ≥ 25.0 kg/m2,n=63) groups. Preoperative radiotherapy was delivered in 45–50.4 Gy/25f, 5 days/week, and concurrent chemotherapy using FOLFOX or CapeOX. Technical feasibility, postoperative and oncological outcome were compared between groups.Results.Obese patients had significantly longer operative time (P=0.004). There was no significant difference regarding estimated blood loss, conversion, postoperative recovery, and morbidities. Multivariate analysis demonstrated that higher ASA score and abdominoperineal resection were risk factors for postoperative complications and diverting stoma was a protective factor. The length of resection margin, circumferential resection margin involvement, and number of lymph node retrieved were comparable. With a median follow-up time of 55 months (ranging 20–102 months), oncological outcome was comparable in terms of overall survival, local recurrence, and distant metastasis.Conclusions.Obesity does not affect surgical or oncological outcome of laTME after nCRT. LaTME may be feasible and safe to obese LARC patients after nCRT in a specialized center.

Sign in / Sign up

Export Citation Format

Share Document