scholarly journals Routine defunctioning stoma after chemoradiation and total mesorectal excision: A single-surgeon experience

2013 ◽  
Vol 19 (11) ◽  
pp. 1797 ◽  
Author(s):  
Shao-Chieh Lin
Keyword(s):  
Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Defunctioning Stoma ◽  
Surgeon Experience

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.

Prospective Evaluation of Selective Defunctioning Stoma for Low Anterior Resection with Total Mesorectal Excision

1999 ◽  
Vol 23 (5) ◽  
pp. 463-468 ◽  
Author(s):  
Ronnie Tung-Ping Poon ◽  
Kin-Wah Chu ◽  
Judy Wai-Chu Ho ◽  
Cheung-Wah Chan ◽  
Wai-Lun Law ◽  
...  
Keyword(s):  
Total Mesorectal Excision ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Prospective Evaluation ◽  
Mesorectal Excision ◽  
Defunctioning Stoma

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

2018 ◽  
Vol 90 (3) ◽  
pp. 31-36 ◽  
Author(s):  
Stanislav Chernyshov ◽  
Mikhail Alexeev ◽  
Evgeny Rybakov ◽  
Mikhail Tarasov ◽  
Yuri Shelygin ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Total Mesorectal Excision ◽  
Negative Impact ◽  
Univariate Analysis ◽  
Operating Time ◽  
Mesorectal Excision ◽  
Defunctioning Stoma ◽  
Predictive Values ◽  
Restorative Proctectomy ◽  
Perioperative Blood Transfusion

Background: This study aims to examine the factors involved in anastomotic leak (AL) following low anterior resection and total mesorectal excision (LAR-TME) and to determine the usefulness of early measurement of the inflammatory biomarkers C-Reactive Protein (CRP) and Procalcitonin (PCT). Methods: One hundred patients undergoing LAR-TME with a proximal diverting stoma were analyzed between 2013 and 2016. Postoperative CRP and PCT levels were measured on the 3rd and the 6th postoperative days. Results: There were 11 clinical leaks with a negative impact in univariate analysis on AL of male gender, larger and stenotic tumours, intraoperative blood loss > 200 mL, the need for perioperative blood transfusion, postoperative anaemia and an operating time exceeding 180 minutes. On multivariate analysis, only perioperative blood transfusion was an independent AL risk factor. Recorded CRP was higher in AL patients when compared with non-AL cases on both the 3rd postoperative day (152.4 mg/L vs. 93 mg/L, respectively; P < 0.0001) and the 6th postoperative day (130.5 mg/L vs. 68.2 mg/L; P < 0.0001). The PCT levels also significantly differed between AL and non-AL cases on the 3rd postoperative day (0.5 ng/mL vs. 0.2 ng/mL, respectively; P < 0.0001) and the 6th postoperative day (1.16 ng/mL vs. 0.1 ng/mL, respectively; P < 0.0001). Both CRP and PCT showed high negative predictive values (NPV) for the diagnosis of an AL on both postoperative days. Conclusion: Following low restorative proctectomy, the high NPV of CRP and PCT measurements for the diagnosis of anastomotic leaks may assist decision-making for early hospital discharge.

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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