scholarly journals Complete Mesogastric Excisions Involving Anatomically Based Concepts and Embryological-Based Surgeries: Current Knowledge and Future Challenges

2021 ◽  
Vol 28 (6) ◽  
pp. 4929-4937
Author(s):  
Sergii Girnyi ◽  
Marcin Ekman ◽  
Luigi Marano ◽  
Franco Roviello ◽  
Karol Połom
Keyword(s):  
Current Knowledge ◽  
Rectal Surgery ◽  
Standard Technique ◽  
Lymphatic Drainage ◽  
Rectal Cancer Surgery ◽  
Mesorectal Excision ◽  
Technical Aspects ◽  
Future Challenges ◽  
Oncological Results ◽  
Initial Results

Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This concept was initially proposed in rectal surgery and called a total mesorectal excision. This procedure gained much interest and has improved oncological results in rectal cancer surgery. The same idea for mesogastric and complete mesogastric excisions was proposed but, because of the complexity of the gastric mesentery, it has not become a standard technique. In this review, we analysed anatomical and embryological factors, proposed technical aspects of this operation and incorporated the available initial results of this concept. We also discussed analogies to other gastrointestinal organs, as well as challenges to this concept.

scholarly journals Transanal Total Mesorectal Excision: Why, When, and How

2017 ◽  
Vol 30 (05) ◽  
pp. 339-345 ◽  
Author(s):  
Marta Penna ◽  
Christopher Cunningham ◽  
Roel Hompes
Keyword(s):  
Total Mesorectal Excision ◽  
Rectal Surgery ◽  
Autonomic Nerves ◽  
Controlled Trials ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Randomized Controlled ◽  
The Past ◽  
Initial Results ◽  
Pelvic Autonomic Nerves

AbstractTransanal total mesorectal excision (taTME) has evolved over the past decade fueled by advances in minimally invasive surgery. The technique aims to overcome the constraints posed by a narrow rigid pelvis and poor TME visualization that are encountered during “top-down” rectal surgery. A more accurate pelvic dissection should subsequently result in safer oncological resections and better preservation of pelvic autonomic nerves. taTME is an advanced complex technique that requires dedicated training and experience in TME surgery. Initial results from small cohorts are promising and confirmation by randomized controlled trials is eagerly awaited.

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 Total Mesorectal Excision Technique—Past, Present, and Future

2020 ◽  
Vol 33 (03) ◽  
pp. 134-143 ◽  
Author(s):  
Joep Knol ◽  
Deborah S. Keller
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Standard Procedure ◽  
Preoperative Staging ◽  
Lymphatic Drainage ◽  
Oncologic Outcomes ◽  
Rectal Cancer Surgery ◽  
Mesorectal Excision ◽  
Abdominal Approach ◽  
Pathologic Assessment

AbstractWhile the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic assessment, the development and timing of multimodal therapies, and surgical technique. The most significant contribution in advancing rectal cancer care may be the standardization and widespread implementation of total mesorectal excision (TME). The TME, popularized by Professor Heald in the early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all associated lymph nodes through the avascular embryologic plane, has shown universal reproducible reductions in local recurrence and improvement in disease-free and overall survival. Widespread education and training of surgeons worldwide in the TME have significantly impact outcomes for rectal cancer surgery, and the procedure has become the gold standard for curative resection of rectal cancer. In this article, we discuss the evolution of the standard abdominal approach to the TME, with emphasis on the history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical evolution.

scholarly journals Prevalence of Metastatic Lateral Lymph Nodes in Asian Patients with Lateral Lymph Node Dissection for Rectal Cancer: A Meta-analysis

2021 ◽  
Author(s):  
Niki Christou ◽  
Jeremy Meyer ◽  
Christophe Combescure ◽  
Alexandre Balaphas ◽  
Joan Robert-Yap ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Meta Analysis ◽  
Neoadjuvant Treatment ◽  
Rectal Surgery ◽  
Node Dissection ◽  
Asian Countries ◽  
Mesorectal Excision ◽  
Lateral Lymph Node ◽  
Pooled Prevalence ◽  
Leave One Out

Abstract Importance Rectal cancers occupy the eighth position worldwide for new cases and deaths for both men and women. These cancers have a high tendency to form metastases in the mesorectum but also in the lateral lymph nodes. The therapeutic approach for the involved lateral lymph nodes remains controversial. Objective We performed a systematic review and meta-analysis to assess the prevalence of metastatic lateral lymph nodes in patients with lateral lymph node dissection (LLND) for rectal cancer, which seems to be a fundamental and necessary criterion to discuss any possible indications for LLND. Methods Data sources–study selection–data extraction and synthesis–main outcome and measures. We searched MEDLINE, EMBASE and COCHRANE from November 1, 2018, to November 19, 2018, for studies reporting the presence of metastatic lateral lymph nodes (iliac, obturator and middle sacral nodes) among patients undergoing rectal surgery with LLND. Pooled prevalence values were obtained by random effects models, and the robustness was tested by leave-one-out sensitivity analyses. Heterogeneity was assessed using the Q-test, quantified based on the I2 value and explored by subgroup analyses. Results Our final analysis included 31 studies from Asian countries, comprising 7599 patients. The pooled prevalence of metastatic lateral lymph nodes was 17.3% (95% CI: 14.6–20.5). The inter-study variability (heterogeneity) was high (I2 = 89%). The pooled prevalence was, however, robust and varied between 16.6% and 17.9% according to leave-one-out sensitivity analysis. The pooled prevalence of metastatic lymph nodes was not significantly different when pooling only studies including patients who received neoadjuvant treatment or those without neoadjuvant treatment (p = 0.44). Meta-regression showed that the pooled prevalence was associated with the sample size of studies (p < 0.05), as the prevalence decreased when the sample size increased. Conclusion The pooled prevalence of metastatic lateral lymph nodes was 17.3% among patients who underwent rectal surgery with LLND in Asian countries. Further studies are necessary to determine whether this finding could impact the therapeutic strategy (total mesorectal excision with LLND versus total mesorectal excision with neoadjuvant radiochemotherapy).

Numerical modeling of the Lusi hydrothermal system: Initial results and future challenges

2018 ◽  
Vol 90 ◽  
pp. 191-200 ◽  
Author(s):  
Reza Sohrabi ◽  
Gunnar Jansen ◽  
Benjamin Malvoisin ◽  
Adriano Mazzini ◽  
Stephen A. Miller
Keyword(s):  
Numerical Modeling ◽  
Hydrothermal System ◽  
Future Challenges ◽  
Initial Results

scholarly journals Synthetic protocell biology: from reproduction to computation

2007 ◽  
Vol 362 (1486) ◽  
pp. 1727-1739 ◽  
Author(s):  
Ricard V Solé ◽  
Andreea Munteanu ◽  
Carlos Rodriguez-Caso ◽  
Javier Macía
Keyword(s):  
Current Knowledge ◽  
Building Blocks ◽  
Biochemical Networks ◽  
Cellular Structures ◽  
Biological Complexity ◽  
Artificial Cell ◽  
Future Challenges ◽  
Cooperative Dynamics ◽  
The Origin Of Life ◽  
Review Current

Cells are the building blocks of biological complexity. They are complex systems sustained by the coordinated cooperative dynamics of several biochemical networks. Their replication, adaptation and computational features emerge as a consequence of appropriate molecular feedbacks that somehow define what life is. As the last decades have brought the transition from the description-driven biology to the synthesis-driven biology, one great challenge shared by both the fields of bioengineering and the origin of life is to find the appropriate conditions under which living cellular structures can effectively emerge and persist. Here, we review current knowledge (both theoretical and experimental) on possible scenarios of artificial cell design and their future challenges.

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