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

scholarly journals LARS is Associated with Lower Anastomoses, but not with the Transanal Approach in Patients Undergoing Rectal Cancer Resection

2020 ◽  
Author(s):  
Alexandra Filips ◽  
Tobias Haltmeier ◽  
Andreas Kohler ◽  
Daniel Candinas ◽  
Lukas Brügger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Regression Coefficient ◽  
Anal Verge ◽  
Transanal Approach ◽  
Cancer Resection ◽  
Rectal Cancer Resection ◽  
The Impact

Abstract Background Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer. Methods We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy. Results At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient:  − 2.147, 95%CI:  − 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient:  − 1.145, 95%CI:  − 2.149 to  − 1.141, p = 0.026). Conclusion Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.

Precision Surgery In Rectal Resection With Hyperspectral And Fluorescence Imaging And Pelvic Intraoperative Neuromonitoring (With Video)

2021 ◽  
Author(s):  
Boris Jansen-Winkeln ◽  
Mathias Mehdorn ◽  
Undine Lange ◽  
Hannes Köhler ◽  
Claire Chalopin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Fluorescence Imaging ◽  
Functional Outcomes ◽  
Rectal Resection ◽  
Intraoperative Imaging ◽  
Intraoperative Neuromonitoring ◽  
Data Driven ◽  
Mesorectal Excision ◽  
Narrow Pelvis

Oncologic visceral surgery has recently been revolutionized by robotics, artificial intelligence (AI), sparing of functionally important structures and innovative intraoperative imaging tools. These techniques enable new dimensions of precision surgery and oncology. Currently, data-driven, cognitive operating rooms are standing at the forefront of the latest technical and didactic developments in abdominal surgery. Rectal low anterior resection with total mesorectal excision (TME) for lower- and middle-third rectal cancer is a challenging operation due to the narrow pelvis and the tender guiding structures. Thus, new approaches have been needed to simplify the procedure and to upgrade the results. The combination of robotics with pelvic intraoperative neuromonitoring (pIONM) and new possibilities of visualization, such as multi- and hyperspectral imaging (MSI / HSI) or fluorescence imaging (FI) with indocyanine green (ICG) is a forward-looking modality to enhance surgical precision and reduce postoperative complications while improving oncologic and functional outcomes with a better quality of life. The aim of our video-paper is to show how to achieve maximum precision by combining robotic surgery with pelvic intraoperative neuromonitoring and new imaging devices for rectal cancer.

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.

scholarly journals Comparison between robotic-assisted and laparoscopic sphincter-preserving operations for ultra-low rectal cancer: a single institutional retrospective study

2021 ◽  
Author(s):  
Tadahiro Kojima ◽  
Hitoshi Hino ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
Yusuke Yamaoka ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Multivariate Analyses ◽  
Anal Verge ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery

Abstract Background Sphincter-preserving operations for ultra-low rectal cancer include low anterior resection and intersphincteric resection. In low anterior resection, the distal rectum is divided by a transabdominal approach, which is technically demanding. In intersphincteric resection, a perineal approach is performed. We aimed to evaluate whether robotic-assisted surgery is technically superior to laparoscopic surgery for ultra-low rectal cancer. The frequency of conducting low anterior resection by a specific procedure can indicate the technical superiority of that procedure for ultra-low rectal cancer. Thus, we compared the frequency of low anterior resection between robotic-assisted and laparoscopic surgery in cases of sphincter-preserving operations. Methods We investigated 183 patients who underwent sphincter-preserving robotic-assisted or laparoscopic surgery for ultra-low rectal cancer (lower border within 5 cm of the anal verge) between April 2010 and March 2020. The frequency of low anterior resection was compared between laparoscopic and robotic-assisted surgeries. The clinicopathological factors associated with an increase in performing low anterior resection were analyzed by multivariate analyses. Results Overall, 41 (22.4%) and 142 (77.6%) patients underwent laparoscopic and robotic-assisted surgery, respectively. Patient characteristics were similar between the groups. Low anterior resection was performed significantly more frequently in robotic-assisted surgery (67.6%) than in laparoscopic surgery (48.8%) (p = 0.04). Multivariate analyses showed that tumor distance from the anal verge (p < 0.01) and robotic-assisted surgery (p = 0.02) were significantly associated with an increase in the performance of low anterior resection. The rate of postoperative complications or pathological results was similar between the groups. Conclusions Compared with laparoscopic surgery, robotic-assisted surgery significantly increased the frequency of low anterior resection in sphincter-preserving operations for ultra-low rectal cancer. Robotic-assisted surgery has technical superiority over laparoscopic surgery for ultra-low rectal cancer treatment.

scholarly journals Initial Experience with the Safe Implementation of Transanal Total Mesorectal Excision (TaTME) as a Standardized Procedure for Low Rectal Cancer

2020 ◽  
Vol 10 (1) ◽  
pp. 72 ◽  
Author(s):  
Luca Dittrich ◽  
Matthias Biebl ◽  
Rosa Schmuck ◽  
Safak Gül ◽  
Sascha Weiss ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Anal Verge ◽  
Neoadjuvant Chemoradiotherapy ◽  
Laparoscopic Approach ◽  
Oncological Outcome ◽  
Low Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Conversion Rates

Introduction: The laparoscopic approach for TME is proven to be non-inferior in oncological outcome compared to open surgery. Anatomical limitations in the male and obese pelvis with resulting pathological shortcomings and high conversion rates were stimuli for alternative approaches. The transanal approach for TME (TaTME) was introduced to overcome these limitations. The aim of this study was to evaluate the outcomes of TaTME for mid and low rectal cancer at our center. Methods: TaTME is a hybrid procedure of simultaneously laparoscopic and transanal mesorectal excision. A retrospective analysis of all consecutive TaTME procedures performed at our center for mid and low rectal cancer between December 2014 and January 2020 was conducted. Results: A total of 157 patients underwent TaTME, with 72.6% receiving neoadjuvant chemoradiation. Mean tumor height was 6.1 ± 2.3 cm from the anal verge, 72.6% of patients had undergone neoadjuvant chemoradiotherapy, and 34.2% of patients presented with a threatened CRM upon pretherapeutic MRI. Abdominal conversion rate was 5.7% with no conversion for the transanal dissection. Early anastomotic leakage occurred in 7.0% of the patients. Mesorectum specimen was complete in 87.3%, R1 resection rate was 4.5% (involved distal resection margin) and in 7.6%, the CRM was positive. The three-year local recurrence rate of 58 patients with a follow-up ≥ 36 months was 3.4%. Overall survival was 92.0% after 12 months, and 82.2% after 36 months. Conclusion: TaTME can be performed safely with acceptable long-term oncological outcome. Low rectal cancer can be well addressed by TaTME, which is an appropriate alternative with low conversion, local recurrence, adequate mesorectal quality and CRM positivity rates.

scholarly journals Transanal total mesorectal excision for patients with middle-low rectal cancer in locally advanced stage

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Huu Thien Ho ◽  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Rectal Resection ◽  
Locally Advanced ◽  
Low Rectal Cancer ◽  
Resection Margins ◽  
Transanal Total Mesorectal Excision ◽  
Advanced Stage ◽  
Mesorectal Excision ◽  
Female Ratio

Abstract Introduction: Patients with middle-low rectal cancer in advanced stage had many difficulties in performing laparoscopic total mesorectal excision (TME), especially in those with narrow pelvis or obese with or without neoadjuvant therapy. We conducted the study of transanal TME (TaTME) for these patients to evaluate the safety and efficacity of this technique. Material and Methods: Prospective study. Patients with middle-low rectal cancer in advanced stage underwent rectal resection with TaTME technique were enrolled. Results: 38 patients including 25 middle and 13 low rectal tumors underwent elective rectal resection by TaTME from March 2015 to September 2018. Male/female ratio: 25/13. Mean age: 58.2 ± 16.4 and BMI: 24.2 ±2.5 kg/m2. Mean operation duration:210 ± 42 minutes. Specimen were removed through abdominal incision in 23 patients and 15 via anus. Anastomoses were performed by hands in 100% patients. The protective ileostomie was performed 100%. One left ureteral burning and postoperative difficulty in voiding, one presacral abscess due to anastomotic fistula and one totally leakage of the anastomose. Good Quirke assessment in 87% patients. The distal resection margins (DRM) was 20 ± 5 mm. Distal resection margins (DRM) were negative in 100% patients and circumferential resection margins (CRM) were positive in one (2.6%) patients. The hospital stay was 6 days. Median follow-up time was 12 months. One patient had local recurrence at 18th months and 1 had liver metastasis at 6th months. Conclusion: TaTME for patients with middle-low rectal cancer in advanced stage is safe and efficacious. However, there is a need for large, multicentric studies to accurately evaluate this technique.

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