scholarly journals Total Mesorectal Excision for Mid-Rectal Cancer Without Anastomosis: Low Hartmann’s Operation or Intersphincteric Abdomino-Perineal Excision?

2018 ◽  
Vol 108 (3) ◽  
pp. 233-240
Author(s):  
M. Popiolek ◽  
K. Dehlaghi ◽  
S. Gadan ◽  
B. Baban ◽  
P. Matthiessen
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Colorectal Anastomosis ◽  
Operation Time ◽  
Perineal Wound ◽  
Pelvic Abscess ◽  
Hartmann’S Procedure ◽  
Mesorectal Excision ◽  
Hartmann's Procedure ◽  
Tumor Level

Background and Aims: In mid-rectal cancer, the low colorectal anastomosis is, although feasible, sometimes avoided. The aim was to compare low Hartmann’s procedure with intersphincteric abdomino-perineal excision of the rectum, in patients operated with total mesorectal excision for mid-rectal cancer in whom the low anastomosis was technically feasible but for patient-related reasons undesired. Material and Methods: A total of 64 consecutive patients with mid-rectal cancer who underwent low Hartmann’s procedure (n = 34) or intersphincteric abdomino-perineal excision (n = 30) at one colorectal unit were compared regarding patient demography, short-term oncology, surgical outcome at 3 and 24 months, and long-term overall survival. Results: There were no significant differences between intersphincteric abdomino-perineal excision and Hartmann’s procedure regarding age, gender distribution, body mass index, preoperative radiotherapy, tumor level, or cancer stages. Operation time was shorter in Hartmann’s procedure as compared with intersphincteric abdomino-perineal excision, median 174 and 256 min, (P < 0.001), and intraoperative blood loss was increased, 600 and 500 mL, respectively (P = 0.045). Number of lymph nodes and circumferential resection margin were comparable. In Hartmann’s procedure compared with intersphincteric abdomino-perineal excision, the need for reoperation was 24% and 3%, (P = 0.020), complications classified as Clavien–Dindo 3–4 occurred in 32% and 10%, (P = 0.031), pelvic abscess in 21% and 10%, (P = 0.313), and mortality within 90 days was 3% and 0%, respectively, (P = 0.938). In intersphincteric abdomino-perineal excision, the perineal wound was not healed at 3 months in 13%, and in Hartmann’s procedure 15% had chronic secretion from the anorectal remnant at 2 years postoperatively. Conclusion: The results from this study suggest that intersphincteric abdomino-perineal excision might be an alternative to Hartmann’s procedure in patients with mid-rectal cancer, in whom a low colorectal anastomosis is undesired.

scholarly journals COMPARATIVE ANALYSIS OF OPEN AND TRANSANAL TOTAL MESORECTAL EXCISION FOR RECTAL CANCER

2018 ◽  
pp. 67-73 ◽  
Author(s):  
Yu. A. Shelygin ◽  
S. V. Chernyshov ◽  
L. Yu. Kazieva ◽  
O. A. Maynovskaya ◽  
V. N. Kashnikov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Cancer Patients ◽  
Intraoperative Complications ◽  
Randomized Study ◽  
Operation Time ◽  
Invasive Technique ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Significant Difference

AIM: to evaluate results of transanal total mesorectal excision (TA TME) for rectal cancer. PATIENTS AND METHODS: Ninuty patients were included the prospective non-randomized study. Forty-five (50.0 %) of them underwent TA TME and 45 (50.0%) - conventional total mesorectal excision (TME). RESULTS: operation time was significantly higher in TA TME group: 276.4± 56.9 (190-400) minutes vs 188.0± 56.7 (100-310) minutes in open TME group (р=0.0001). The intraoperative complications rate was significantly higher in TA TME group: 7 (15.5 %) vs 1 (2.2 %) patient (р=0.05). No significant difference in postoperative morbidity was obtained: 18 (40.0%) in TA TME group vs 17 (37.7%) (р=1.0). Postoperative stay was lower in TATME group: 9 (7:14) vs 11 (10:14) days (р=0.04). Grade 2 specimen quality was detected significantly more often after TATME 26 (57.8 %) vs 15 (33.3 %) open TME (р=0.03), while Grade 3 specimens were more common after open procedure - 30 (66.7 %) vs 13 (28.9 %) TA TME group (р=0.0006). CONCLUSION: TA TME is a feasible procedure for rectal cancer patients. It demonstrated all benefits of minimally invasive technique, though learning curve is steep.

scholarly journals The role of Hartmann’s procedure in the elective management of rectal cancer: results of a Brazilian cohort study

2021 ◽  
Vol 48 ◽  
Author(s):  
ANDERSON RECH LAZZARON ◽  
INGRID SILVEIRA ◽  
PAULINE SIMAS MACHADO ◽  
DANIEL C DAMIN
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Surgical Complications ◽  
Rectal Resection ◽  
Colorectal Anastomosis ◽  
Hartmann’S Procedure ◽  
Septic Complications ◽  
Elective Resection ◽  
Defunctioning Stoma ◽  
Hartmann's Procedure

ABSTRACT Background: although preservation of bowel continuity is a major goal in rectal cancer surgery, a colorectal anastomosis may be considered an unacceptably high-risk procedure, particularly for patients with multiple comorbidities. We aimed to assess rates of surgical complications in rectal cancer patients according to the type of procedure they had undergone. Materials and Methods: this cohort included all rectal cancer patients undergoing elective resection at a referral academic hospital over 16 years. There were three study groups according to the type of performed operation: (1) rectal resection with anastomosis without defunctioning stoma (DS); (2) rectal resection with anastomosis and DS; and (3) Hartmann’s procedure (HP). Postoperative complications and clinical outcomes were assessed. Results: four-hundred and two patients were studied. The 118 patients in group 3 were significantly older (>10 years), had higher Charlson Comorbidity Index scores, and more ASA class ≥3 than patients in the other two groups. Sixty-seven patients (16.7%) had Clavien-Dindo complications grade ≥ III, corresponding to an incidence of 11.8%, 20.9%, and 14.4% in groups 1, 2, and 3, respectively (p=0.10). Twenty-nine patients (7.2%) had major septic complications that required reoperation, with an incidence of 10.8%, 8.2% and 2.5% in groups 1, 2 and 3, respectively (p=0.048). Twenty-one percent of the group 2 patients did not undergo the stoma closure after a 24-month follow-up. Conclusion: HP was associated with a lower incidence of reoperation due to intra-abdominal septic complications. This procedure remains an option for patients in whom serious surgical complications are anticipated.

Short-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Cohort Study

2019 ◽  
Vol 85 (3) ◽  
pp. 294-302
Author(s):  
Wen-Han Liu ◽  
Pei-Jing Yan ◽  
Dong-Ping Hu ◽  
Peng-Hui Jin ◽  
Yao-Chun Lv ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Recovery Time ◽  
Statistical Significance ◽  
Operation Time ◽  
Laparoscopic Total Mesorectal Excision ◽  
Intestinal Function ◽  
Mesorectal Excision ◽  
Short Term ◽  
Function Recovery

The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus ( P < 0.001), the time to the first postoperative oral fluid intake ( P < 0.001), and the length of hospital stay ( P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy ( P = 0.038) and postoperative urinary retention ( P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group ( P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.

TRANSANAL TOTAL MESORECTAL EXCISION OF RECTAL CANCER TREATMENT

2019 ◽  
pp. 41-45
Author(s):  
Viet Hung Tran ◽  
Anh Vu Pham ◽  
Nhu Hiep Pham ◽  
Huu Thien Ho ◽  
Hai Thanh Phan ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Endoscopic Surgery ◽  
Operation Time ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Conversion To Open Surgery ◽  
Early Results ◽  
Hybrid Notes ◽  
Group B

Purpose: To evaluate the early results of the feasibility and safety on technology and oncologic transanal total mesorectal excision (down to up). Materils and method: Prospective study from 2012 to 2018. Patients: 23 rectum adenocarcinoma staging T ≤ 3, N ≤ 1, M0 were operated using one of two modalities Hybrid NOTES (A) and NOTES (B). Results: Twenty three patients with Rectal cancer were sucessfully in total mesorectal excision performed by Hybrid NOTES and NOTES procedures. Three cases in group NOTES had per-operative complications such as bleeding or urethra injury required one or two trocarts for assistance, no conversion to open surgery and no mortality. The operation time: group A (Hybrid NOTES): 190 ± 47 (120-280) mins; group B (NOTES): 258 ± 40 (190-300) mins. The hospital stay: 9 ± 2.7 (4-19) day. Conclusions: transanal total mesorectal excision (down to up) endoscopic surgery (NOTES) and Hybrid NOTES is feasible and safe.However, a study in a large number of patient and long follow-up is necessary. Key words: Mesorectum, Natural orifice transluminal endoscopic surgery (NOTES), Hybrid NOTES, rectal cancer

scholarly journals The role of transanal drainage tube in low anterior resection for rectal cancer

2021 ◽  
Vol 102 (3) ◽  
pp. 335-341
Author(s):  
F Sh Akhmetzyanov ◽  
V I Egorov ◽  
D M Ruvinskiy ◽  
O V Lûtikovа
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Small Samples ◽  
Mesorectal Excision ◽  
Surgical Interventions ◽  
Anterior Rectal Resection ◽  
Intestinal Stoma

Total mesorectal excision with low anterior resection has significantly improved the long-term outcomes of surgical treatment for rectal cancer, decreasing the local recurrence rate and increasing survival. However, total mesorectal excision is becoming one of the main factors for the development of colorectal anastomosis leakage, the rate of which reaches 20% in these operations. To minimize the complications associated with the inconsistency of the colorectal anastomotic suture, preventive intestinal stoma is formed when performing low anterior resections. That significantly worsen the quality of life of patients, their elimination requires re-hospitalization, and surgical interventions are accompanied by a high incidence of postoperative complications, reaching a rate of 20%, which has a significant impact on the cost of treatment for this category of patients. Transanal drainage is an alternative to the formation of preventive intestinal stoma and is devoid of its shortcomings. This literature review is devoted to an analysis of the effectiveness of transanal drainage in low anterior rectal resection. Until recently, transanal drainage has not yet gained popularity among surgeons due to the lack of evidence of its safety and effectiveness, and many studies are retrospective, including small samples. The review considered single-center, multicenter, randomized trials and a meta-analysis of the use of transanal drainage. Transanal drainage is an effective method for preventing the inconsistency of colorectal anastomotic suture, it is safe, and it surpasses the preventive intestinal stoma in a number of indicators.

Wasmuth HH, Færden AE, Myklebust TÅ, et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–30

2020 ◽  
Vol 14 (3) ◽  
pp. 155-158
Author(s):  
M. Aubert ◽  
Y. Panis
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Cancer Du Rectum ◽  
Prise En Charge ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Récidive Locale ◽  
Kaplan Meier ◽  
Cancers Colorectaux ◽  
Technique Chirurgicale

Contexte : L’exérèse totale du mésorectum par voie transanale (TaTME) pour la prise en charge du cancer du rectum est récemment apparue comme alternative à l’exérèse totale du mésorectum par voie abdominale. Cependant, certaines inquiétudes à propos des résultats oncologiques de cette technique chirurgicale ont émergé. Le but de cette étude était d’évaluer le taux de récidives locales après TaTME. Les objectifs secondaires s’intéressaient à la mortalité postopératoire, au taux de fistule anastomotique et au taux de stomie définitive. Méthodes : Les données de tous les patients opérés par TaTME ont été rapportées et comparées aux données issues des registres nationaux norvégiens de cancers colorectaux (NCCR) et de chirurgie gastro-intestinale (NoRGast). Les taux de récidive locale étaient estimés selon Kaplan-Meier. Résultats : En Norvège, 157 patients ont été opérés par TaTME pour un cancer du rectum entre octobre 2014 et octobre 2018. Trois des sept centres hospitaliers participants ont abandonné la réalisation de cette intervention après cinq procédures. Le taux de récidive locale était de 12 sur 157 patients (7,6 %) ; huit récidives locales étaient multifocales ou étendues. Le taux de récidive locale après un suivi de à 2,4 ans était estimé à 11,6 % (IC 95 % : [6,6‒19,9]) après TaTME contre 2,4 % (IC 95 % : [1,4‒4,4]) dans le registre NCCR (p < 0,001). Le hasard ratio était estimé à 6,71 (IC 95 % : [2,94‒15,32]). Le taux de fistule anastomotique nécessitant une réintervention était de 8,4 % dans le groupe TaTME contre 4,5 % dans le registre NoRGast (p = 0,047). Cinquante-six patients (35,7 %) étaient porteurs d’une stomie à la fin du suivi, dont 39 (24,8 %) étaient définitives. Conclusion : Le taux de fistule anastomotique était plus élevé après TaTME en comparaison aux données des registres nationaux norvégiens. Le taux de récidive locale ainsi que les caractéristiques de cette récidive après TaTME étaient défavorables.

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