Use of the End to End Anastomotic Stapler From Above for Difficult Pelvic Surgery for Distal Rectal Disease

2020 ◽  
pp. 000313482097162
Author(s):  
Farin F. Amersi ◽  
Byron Wright ◽  
Allan W. Silberman
Keyword(s):  
Rectal Cancer ◽  
Tumor Location ◽  
Hospital Length Of Stay ◽  
Disease Stage ◽  
Pelvic Surgery ◽  
Distal Margin ◽  
Rectal Disease ◽  
Eea Stapler ◽  
Sphincter Function ◽  
End To End

Introduction Transabdominal utilization (TAU) of the end to end anastomotic (EEA) stapler in low anterior resection (LAR) for rectal cancer is an excellent alternative to the most widely performed techhnique. Methods We performed a retrospective analysis of a prospectively maintained database which obtained data on 104 patients with rectal disease who underwent EEA-assisted LAR with TAU. Records of all patients were used to evaluate demographics, complications, tumor location, margin status, postoperative complications, clinical sphincter function, adjuvant or neoadjuvant treatment, disease stage, and survival. Results Of the 104 patients, 48% were women with a mean age of 64 years (range 34-85 years). The average tumor location was 8 cm above the dentate line, and the mean tumor distance from the distal margin was 1.9 cm. All distal margins in cases for patients with rectal cancer were negative. Hospital length of stay averaged 8.7 days (6-15 days). There were no anastomotic complications (leaks, bleeding, or obstruction), and there were no leaks at the separate colotomy site. All patients have had normal postoperative sphincter function. Conclusion Transabdominal utilization of the EEA stapler in LAR for colorectal carcinoma is an alternative to the conventional approach and may be advantageous in avoidance of the lithotomy position with potential nerve injury, risk of deep venous thrombosis, and stapler-induced sphincter trauma.

Options for Low Rectal Cancer: Robotic Total Mesorectal Excision

2021 ◽  
Vol 34 (05) ◽  
pp. 311-316
Author(s):  
Felipe F. Quezada-Diaz ◽  
J. Joshua Smith
Keyword(s):  
Rectal Cancer ◽  
Three Dimensional ◽  
Pelvic Surgery ◽  
Nerve Sparing ◽  
Rectal Cancer Surgery ◽  
Distal Margin ◽  
Open Approach ◽  
Mesorectal Excision ◽  
Short Term ◽  
Conversion Rates

AbstractLow rectal cancers (LRCs) may offer a difficult technical challenge even to experienced colorectal surgeons. Although laparoscopic surgery offers a superior exposure of the pelvis when compared with open approach, its role in rectal cancer surgery has been controversial. Robotic platforms are well suited for difficult pelvic surgery due to its three-dimensional visualization, degree of articulation of instruments, precise movements, and better ergonomics. The robot may be suitable especially in the anatomically narrow pelvis such as in male and obese patients. Meticulous dissection in critical steps, such as splenic flexure takedown, nerve-sparing mesorectal excision, and distal margin clearance, are potential technical advantages. In addition, robotic rectal resections are associated with lower conversion rates to open surgery, less blood loss, and shorter learning curve with similar short-term quality of life outcomes, similar rates of postoperative complications, and equivalent short-term surrogate outcomes compared with conventional laparoscopy. Robotic surgery approach, if used correctly, can enhance the skills and the capabilities of the well-trained surgeon during minimally invasive procedures for LRC.

Effect of Tumor Location on Outcome after Laparoscopic Low Rectal Cancer Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Qingbin Wu ◽  
Zechuan Jin ◽  
Xubing Zhang ◽  
Xiangbing Deng ◽  
Yong Peng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tumor Location ◽  
Cancer Surgery ◽  
Low Rectal Cancer ◽  
Rectal Cancer Surgery

scholarly journals Conditional Survival and Cure of Patients With Colon or Rectal Cancer: A Population-Based Study

2020 ◽  
Vol 18 (9) ◽  
pp. 1230-1237 ◽  
Author(s):  
Seyed M. Qaderi ◽  
Paul W. Dickman ◽  
Johannes H.W. de Wilt ◽  
Rob H.A. Verhoeven
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Population Based ◽  
Stage I ◽  
Stage Iii ◽  
Disease Stage ◽  
Conditional Survival ◽  
Population Based Study ◽  
Pathologic Stage ◽  
Number Of Patients

Background: The increasing number of colorectal cancer (CRC) survivors need survival estimates that account for the time already survived. The aim of this population-based study was to determine conditional survival, cure proportions, and time-to-cure (TTC) of patients with colon or rectal cancer. Materials and Methods: All patients with pathologic stage I–III CRC treated with endoscopy or surgery, diagnosed and registered in the Netherlands Cancer Registry between 1995 and 2016, and aged 18 to 99 years were included. Conditional survival was calculated for those diagnosed before and after 2007. Cure proportions were calculated using flexible parametric models. Results: A total of 175,384 patients with pathologic stage I (25%), II (38%), or III disease (37%) were included. Conditional 5-year survival of patients with stage I, II, and III colon cancer having survived 5 years was 98%, 94%, and 92%, respectively. For patients with stage I–III rectal cancer, this was 96%, 89%, and 85%, respectively. Statistical cure in patients with colon cancer was reached directly after diagnosis (stage I) to 6 years (stage III) after diagnosis depending on age, sex, and disease stage. Patients with rectal cancer reached cure 0.5 years after diagnosis (stage I) to 9 years after diagnosis (stage III). In 1995, approximately 42% to 46% of patients with stage III colon or rectal cancer, respectively, were considered cured, whereas in 2016 this percentage increased to 73% to 78%, respectively. Conclusions: The number of patients with CRC reaching cure has increased substantially over the years. This study’s results provide valuable insights into trends of CRC patient survival and are important for patients, clinicians, and policymakers.

scholarly journals Tumor location as an indication for adjuvant radiotherapy in pT3N0 rectal cancer after surgery

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hai-hua Peng ◽  
Xin-hui Zhou ◽  
Tong-chong Zhou ◽  
Xing-sheng Qiu ◽  
Kai-yun You
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Radiotherapy ◽  
Tumor Location

Urologic surgical procedures in patients with uterus neoplasm and colon-rectal cancer

2008 ◽  
Vol 75 (1) ◽  
pp. 42-48
Author(s):  
G. Marino ◽  
M. Laudi ◽  
L. Capussotti ◽  
P. Zola
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Urinary Tract ◽  
Radical Cystectomy ◽  
Partial Cystectomy ◽  
Pelvic Surgery ◽  
Systemic Complications ◽  
First Case ◽  
Colon And Rectal Cancer

Introduction. During the last 30 years, the multidisciplinary treatments of colon and uterus neoplasm have yielded an increase in total survival rates, fostering therefore the increase of cases with regional relapse involving the urinary tract. In these cases the iterative surgery can be performed, if no disease secondary to pelvic pain, haemostatic or debulking procedure is present, and must be considered and discussed with the patient, according to his/her general status. Materials and Methods. From 1997 to August 2007 we performed altogether 43 pelvic iterative surgeries, with simultaneous urologic surgical procedure because of pelvic tumor relapse in patients with uterus neoplasm and colon and rectal cancer. In 4 cases of anal cancer, the urological procedure were: one radical prostatectomy with continent vesicostomy in the first case, while in the other 3 cases radical pelvectomy with double-barrelled uretero-cutaneostomy In 23 cases of colon cancer, the urologic procedures were: 9 cases of radical cystectomy with double-barrelled uretero-cutaneostomy, 4 cases of radical cystectomy with uretero-ileo-cutaneostomy according to Bricker-Wallace II procedure, and 9 cases of partial cystectomy with pelvic ureterectomy and ureterocystoneostomy according to Lich-Gregoire technique (7 cases) and Lembo-Boari (2 cases) procedure. In 16 cases of uterus cancer, the urological procedure were: 7 cases of partial cystectomy with pelvic ureterectomy and uretero-cystoneostomy according to Lich-Gregoire procedure; in 3 cases, a radical cystectomy with urinary continent cutaneous diversion according to the Ileal T-pouch procedure; 2 cases of total pelvectomy and double uretero-cutaneostomy, and 4 cases of bilateral uretero-cutaneostomy. Results. No patients died in the perioperative time; early systemic complications were: 2 esophageal candidiasis, 1 case of venous thrombosis. Conclusions. The iterative pelvic surgery in the case of oncological relapse involving the urinary tract aims to achieve the best quality of life with the utmost oncological radicality. The equation: eradication of pelvic neoplasm and urinary tract reconstruction, with acceptable quality of life, will be the future target; nevertheless, it is not possible to establish guidelines beforehand, and the therapy must be adapted to each single case.

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