scholarly journals The Role of transanal (Ta) dissection in the management of difficult primary and recurrent rectal cancer

2019 ◽  
Vol 6 (1) ◽  
pp. e000305 ◽  
Author(s):  
Valérie Courval ◽  
Sébastien Drolet ◽  
Alexandre Bouchard ◽  
Philippe Bouchard
Keyword(s):  
Rectal Cancer ◽  
Primary Anastomosis ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Recurrent Rectal Cancer ◽  
Mesorectal Excision ◽  
Final Pathology ◽  
Arterial Bleeding ◽  
History Of ◽  
Difficult Cases

BackgroundThe objective of this study was to review the postoperative and short-term oncological outcomes of our first cohort of patients having had a transanal (Ta) approach for primary or recurrent rectal cancer.MethodsA retrospective chart review was performed on all cases of Ta dissection occurring between 2013 and 2016. We reviewed data concerning case selection, tumour characteristics, perioperative and postoperative data and final pathology.ResultsA total of 24 males were operated for primary (92% (22/24)) or recurrent rectal cancer (8.3% (2/24)). Four patients (16.7% (4/24)) had a history of previous rectal surgery and two had a history of previous Ta total mesorectal excision (TME). A majority of patients were obese, with 58.3% (14/24) having a body mass index >30. The laparoscopic approach was used in the majority of cases (95.8% (23/24)). Most patients had a low anterior resection (95.8% (23/24)). Sixteen patients received a temporary ileostomy (66.7% (16/24)). Three patients suffered perioperative complications (including colonic ischaemia, rectal perforation and arterial bleeding). Five patients (21.7% (5/23)) had an anastomotic leak treated with Ta drainage in two patients. Final pathology revealed negative margins in 95.8% (23/24). TME was considered complete in 87.5% (21/24) overall and in 95% (21/22) when considering only primary cancer cases.ConclusionAccording to our cohort of selected difficult cases, Ta dissection approach helped achieve complete mesorectal excision in complex primary rectal cancer but also allowed for rectal resection in patients with previous rectal surgery. This technique also helped perform a primary anastomosis in these difficult cases.

The Learning Curve for the Laparoscopic Approach to Conservative Mesorectal Excision for Rectal Cancer

2010 ◽  
Vol 251 (2) ◽  
pp. 249-253 ◽  
Author(s):  
Thierry Bege ◽  
Bernard Lelong ◽  
Benjamin Esterni ◽  
Olivier Turrini ◽  
Jerôme Guiramand ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Learning Curve ◽  
Laparoscopic Approach ◽  
Mesorectal Excision

scholarly journals Single-Access Laparoscopic Rectal Surgery Is Technically Feasible

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Siripong Sirikurnpiboon ◽  
Paiboon Jivapaisarnpong
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Total Mesorectal Excision ◽  
Perioperative Complications ◽  
Rectal Surgery ◽  
Anal Canal Cancer ◽  
Mesorectal Excision ◽  
Single Access ◽  
Laparoscopic Rectal Surgery ◽  
The Mean

Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments.Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications.Settings and Design. Prospective study.Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules.Statistical Analysis Used. Mean, minimum–maximum.Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

Clinical Nature and Prognosis of Locally Recurrent Rectal Cancer After Total Mesorectal Excision With or Without Preoperative Radiotherapy

2004 ◽  
Vol 22 (19) ◽  
pp. 3958-3964 ◽  
Author(s):  
Mandy van den Brink ◽  
Anne M. Stiggelbout ◽  
Wilbert B. van den Hout ◽  
Job Kievit ◽  
Elma Klein Kranenbarg ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Total Mesorectal Excision ◽  
Preoperative Radiotherapy ◽  
Distant Metastases ◽  
Recurrent Rectal Cancer ◽  
Mesorectal Excision ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

Purpose To document the clinical nature and prognosis of locally recurrent rectal cancer after total mesorectal excision (TME) with or without 5 × 5 Gy preoperative radiotherapy (PRT) and to identify patient-, disease-, and treatment-related factors associated with differences in prognosis after local recurrence. Patients and Methods For 96 Dutch patients with a local recurrence who participated in a multicenter randomized clinical trial, data on treatments and follow-up were gathered from surgeons and radiation and medical oncologists. Twenty-three patients (24%) had previously been treated with PRT plus TME, and 73 patients (76%) had been treated with TME alone. Eighty-one patients (84%) were followed until death; median follow-up time of the alive patients after local recurrence was 21 months (range, 5 to 48 months). Results Survival after local recurrence in the PRT + TME group was significantly shorter than in the TME group (median survival, 6.1 v 15.9 months; hazard ratio for death, 2.1; P = .008). Patients with a local recurrence in the PRT + TME group had distant metastases more often (74% v 40%; P = .004), underwent surgical resection of local recurrence less often (17% v 35%; P = .11), and received radiotherapy for local recurrence at a total dose ≥ 45 Gy less often (4% v 42%; P = .001) than patients without PRT. In a multivariate analysis, the difference in survival after local recurrence between randomization groups was no longer statistically significant (hazard ratio for death of PRT, 1.53; P = .16). Conclusion The clinical nature and prognosis of patients with locally recurrent rectal cancer has changed since the introduction of PRT. The majority of patients who present with a local recurrence after previous PRT have simultaneous distant metastases, and median survival has decreased to 6 months.

scholarly journals Is There Any Reason Not to Perform Standard Laparoscopic Total Mesorectal Excision?

2017 ◽  
Vol 30 (05) ◽  
pp. 333-338 ◽  
Author(s):  
Zaher Lakkis ◽  
Yves Panis
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Locally Advanced ◽  
Rectal Surgery ◽  
Advanced Rectal Cancer ◽  
Oncologic Outcomes ◽  
Mesorectal Excision ◽  
Laparoscopic Tme

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.

scholarly journals Impact of a history of metastases or synchronous metastases on survival in patients with locally recurrent rectal cancer

2021 ◽  
Author(s):  
E. L. K. Voogt ◽  
D. M. G. I. Zoggel ◽  
M. Kusters ◽  
G. A. P. Nieuwenhuijzen ◽  
J. S. Cnossen ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Recurrent Rectal Cancer ◽  
Locally Recurrent Rectal Cancer ◽  
History Of ◽  
Locally Recurrent ◽  
Synchronous Metastases
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