Laparoscopic Total Mesorectal Excision for Ultralow Rectal Cancer with Transanal Intersphincteric Dissection as a First Step: A Single-surgeon Experience

2014 ◽  
Vol 80 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Riccardo Maglio ◽  
Massimo Meucci ◽  
Marco Gallinella Muzi ◽  
Marianna Maglio ◽  
Luigi Masoni
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Postoperative Mortality ◽  
Low Rectal Cancer ◽  
Rectal Disease ◽  
Mesorectal Excision ◽  
Estimated Blood Loss ◽  
Surgeon Experience

Laparoscopic intersphincteric resection (ISR) after neoadjuvant chemoradiation is helpful in the management of patients with low rectal cancer. With the advent of this technique, the need for performance of abdominoperineal resection seems to have decreased in patients with very low rectal tumors. The aim of the present study was to evaluate the feasibility of laparoscopic ISR preceded by transanal rectal dissection low rectal cancer. Between December 2009 and June 2011, we performed laparoscopic ISR for 30 patients with very low rectal cancer. Patients received preoperative concurrent chemoradiation (5 days a week for 5 weeks). The surgical procedure was performed 6 weeks after radiotherapy and included total mesorectal excision, ISR, transanal coloanal anastomosis with coloplasty and loop ileostomy. Clinical data of 30 patients were analyzed retrospectively. Thirty patients (21 men, nine women) had a median age of 65 years (range, 37 to 75 years), a median body weight of 67 kg (range, 43 to 96 kg), and body mass index of 24 kg/m2 (range, 19 to 33 kg/m2). The distance of the tumor from the anal verge was 5 cm (range, 2 to 11 cm). The operative time was from 240 to 360 minutes, and estimated blood loss was 100 to 520 mL. There were no conversions and no postoperative mortality. This procedure is feasible and has favorable short-term results for radical treatment of very low rectal disease while preserving anal function.

Perioperative outcomes for robotic total mesorectal excision after preoperative chemoradiation for rectal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 732-732
Author(s):  
Ibrahim Nassour ◽  
Nicholas Borja ◽  
Ali El-Mokdad ◽  
Hannah Hirsch ◽  
Jeffrey John Meyer ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Major Complication ◽  
Preoperative Chemoradiation ◽  
Low Rectal Cancer ◽  
Perioperative Outcomes ◽  
Mesorectal Excision ◽  
Short Term ◽  
Estimated Blood Loss ◽  
Laparoscopic Tme

732 Background: Laparoscopic total mesorectal excision (TME) after preoperative chemoradiation therapy (P-CRT) for mid to low rectal cancer was shown to be safe and feasible by a recent randomized trial (COREAN trial). However, the safety and short-term efficacy for robotic assisted laparoscopic TME has not been demonstrated. This study is a review of the perioperative outcomes of robotic TME after P-CRT for mid to low rectal cancer at our institution. Methods: All patients that underwent robotic TME after P-CRT for rectal cancer were retrospectively reviewed in our prospectively maintained, IRB-approved surgical oncology database. All relevant demographic, clinical, operative, pathology and perioperative data were analyzed. These were compared to the COREAN trial results. Results: From 2010 to 2014, 42 patients underwent robotic TME for rectal cancer after P-CRT. Mean patient age was 60+/-13. Robotic low anterior resections (R-LAR) were performed in 69% and 31% had a robotic abdominoperineal resection (R-APR). A majority were obese patients as 74% had a BMI ≥ 25, and 50% had an ASA ≥ 3. Conversion to open rate was 9.5% (n = 4) but 3 of these were within the first 8 cases. Median estimated blood loss was 105 ml (50-400 ml). The 30-day major complication rate (Clavien III-IV) was 11.9% (n = 5) and 90-day rate was 14.2% (n = 6). One patient (2.4%) had an anastomotic leak. There were no mortalities within 90-days from operation. Median length of stay was 7 days (6-12 days). Pathological complete response was 19% while 24% had no response. The average number of lymph nodes harvested was 14.2+/-9.5. The circumferential resection margin was negative in 95.2% (n = 40) of patients. Conclusions: As compared to laparoscopic TME patients in the COREAN trial, the robotic patients in our series were more obese and had a higher ASA classification. Our conversion rate was slightly higher, but this was related to the learning curve. All other short-term outcomes were similar. It appears that robotic TME is safe and feasible after P-CRT even among a more obese and higher risk population than previously reported in large series.

OUTCOME OF SPHINCTER PRESERVING RECTAL RESECTION FOR LOW RECTAL CANCER

2017 ◽  
pp. 36-40
Author(s):  
Vinh Quy Truong ◽  
Anh Vu Pham ◽  
Quang Thuu Le
Keyword(s):  
Rectal Cancer ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Rectal Resection ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Central Hospital ◽  
Mesorectal Excision ◽  
Pull Through ◽  
Stage T1

Purpose: To evaluate the functional outcome of sphincter-preserving rectal resection for low rectal cancer. Materials and Methods: From April 2009 to January 2016, there are 52 patients who underwent sphincter-preserving rectal resection with total mesorectal excision with low rectal cancer (<6cm from the anal verge) at Hue Central Hospital, Hue, Vietnam. Results: the average age 62.7 ± 12.8, the distance of tumor from anal verge include four group (≤ 3cm 1.9%; 3 to ≤ 4cm 17.3%; 4 to ≤ 5cm 34.6%; > 5 cm). T stage T1/ T2/T3: 1.9%/28.8%/69.2%. The following time is 33.8 ± 18.9 month. Overall recurrence was 13/18(27.1%), local recurrence was 5 (10.4%). Total survival was 40.5 ± 2.9 month. Technique: intersphincteric preservation 14 (26.9%), low anterior resection 17 (32.7%) and pull-through procedure 21 (40.4%). The distance of anatomosis from anal verge: from 1 to ≤ 2 cm:14 (26.9%); from 2 to ≤ 3cm: 21 (40.4%); from 3 to ≤ 4 cm: 17 (32.7%). Bowels movement of 3 month: 4.7 ± 3.2 and 12th month: 2.7 ± 1.6 (p< 0.01). Conclusions: Sphincterpreserving rectal resection using may provide a good continence and oncologic safety. The patients are acceptable with the results of functional outcomes. Key words: Low rectal cancer, sphincter-preserving

Laparoscopic Total Mesorectal Excision for low rectal cancer ‐ A step by step approach

2021 ◽  
Author(s):  
Naveena AN Kumar ◽  
Nawaz Usman ◽  
Keshava Rajan ◽  
Preethi S Shetty ◽  
Vilas HV Crithic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Low Rectal Cancer ◽  
Laparoscopic Total Mesorectal Excision ◽  
Mesorectal Excision

scholarly journals Survival analysis of local excision vs total mesorectal excision for middle and low rectal cancer in pT1/pT2 stage and intermediate pathological risk

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
I-Li Lai ◽  
Jeng-Fu You ◽  
Yih-Jong Chern ◽  
Wen-Sy Tsai ◽  
Jy-Ming Chiang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Total Mesorectal Excision ◽  
Local Excision ◽  
Therapy Group ◽  
Low Rectal Cancer ◽  
Survival Outcomes ◽  
Mesorectal Excision ◽  
Alternative Treatment Option ◽  
Late Morbidity

Abstract Background Local excision (LE) is a feasible treatment approach for rectal cancers in stage pT1 and presents low pathological risk, whereas total mesorectal excision (TME) is a reasonable treatment for more advanced cancers. On the basis of the pathology findings, surgeons may suggest TME for patients receiving LE. This study compared the survival outcomes between LE with/without chemoradiation and TME in mid and low rectal cancer patients in stage pT1/pT2, with highly selective intermediate pathological risk. Methods This retrospective study included 134 patients who received TME and 39 patients who underwent LE for the treatment of intermediate risk (pT1 with poor differentiation, lymphovascular invasion, perineural invasion, relatively large tumor, or small-sized pT2 tumor) rectal cancer between 1998 and 2016. Results Overall survival (OS), disease-free survival (DFS), and cumulative recurrence rate (CRR) were similar between the LE (3-year DFS 92%) and TME (3-year DFS 91%) groups. Following subgrouping into an LE with adjuvant therapy group and a TME without adjuvant therapy group, the compared survival outcomes (OS, DFS, and CRR) were found not to be statistically different. The temporary and permanent ostomy rates were higher in the TME group than in the LE group (p < 0.001). Rates of early and late morbidity following surgery were higher in the TME group (p = 0.005), and LE had similar survival compared with TME. Conclusion For patients who had mid and low rectal cancer in stage pT1/pT2 and intermediate pathological risk, LE with chemoradiation presents an alternative treatment option for selected patients.

scholarly journals Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Wanglin Li ◽  
Boye Dong ◽  
Baifu Peng ◽  
Jiabao Lu ◽  
Zixin Wu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Hospital Stay ◽  
Single Port ◽  
Low Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Single Port Laparoscopy ◽  
The Mean

Abstract Purpose Glove single-port laparoscopy-assisted transanal total mesorectal excision (TaTME) has been successfully carried out in our medical center. The purpose of this study is to evaluate the feasibility of this emerging operation. Methods This technique was performed by self-made glove single-port laparoscopic platform to radically resect low rectal cancer. Short-term postoperative results, including complications, length of hospital stay, and follow-up results were collected and analyzed statistically. Results There are five consecutive patients (three males, two females) who underwent this surgery and included in this study. The mean distance from the tumor to the anal verge was 4.8 cm (range 4.0–6.0). The surgery was completed in all cases, and the rectal tumor was removed successfully without conversion; circumferential margins of all the excised specimens were negative. The mean time of operation was 338.00 min (range 280–400). The average number of lymph node dissection was 12.20. The average postoperative hospital stay was 8.60 days. During the follow-up (14.80 ± 1.92 months), all preventive ileostomies were successfully closed in about 3 months after the surgery, all patients had satisfactory anal function, and no tumor recurrence was found. Conclusion Glove single-port laparoscopy-assisted TaTME has a significant effect in specific patients with low rectal cancer, with rapid recovery and high safety. Prospective randomized studies involving more case counts and long-term follow-up results, especially oncologic outcomes, are needed to validate this technique.

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