Short-term outcomes of minimally invasive transanal total mesorectal excision for rectal cancer

2021 ◽  
Vol 11 (2) ◽  
Author(s):  
Văn Minh Tuấn Trần ◽  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Case Series ◽  
R0 Resection ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Hospital Patients ◽  
Surgical Duration ◽  
Cancer Laparoscopy

Abstract Introduction: The aim of study was to evaluate the safety and feasibility of transanal total mesorectal excision (TaTME) for middle and low rectal cancer at Binh Dan Hospital. Patients and methods: Case series of all rectal cancer patients who underwent TaTME from January 2019 to July 2020 enrolled. Results: There were 21 patients (17 men and 4 women). The median age of patients was 58 years. The average surgical duration was 264 minutes [210 - 480]. The average blood loss was 168 ml [100 - 210]. The average hospitalization duration was 9.42 days [8 - 16]. There were 2 cases of complication as anastomotic leakage (9.5%) that responded well with conservative treatment. The ratio of R0 resection margin was 100%. There were two cases of positive postoperative circular resection margin (CRM) accounting for 9.5%. The average number of harvested lymph node were 12.34 [9 - 22]. Conclusions: TaTME could be performed safely with good oncological results for rectal cancer. This surgery has advantages for patients with narrow pelvis or obesity. Key word: Rectal cancer, laparoscopy, Transanal Total Mesorectal Excision (TaTME). Tóm tắt Đặt vấn đề: Mục tiêu của nghiên cứu nhằm khảo sát kết quả sớm của phẫu thuật nội soi (PTNS) cắt toàn bộ mạc treo trực tràng qua ngã hậu môn trong điều trị ung thư trực tràng (UTTT). Đối tượng và phương pháp nghiên cứu: Báo cáo loạt ca. Tất cả người bệnh (NB) UTTT được phẫu thuật bằng kỹ thuật cắt toàn bộ mạc treo trực tràng với PTNS qua ngã hậu môn từ tháng 1/2019 đến tháng 7/2020 tại Bệnh viện Bình Dân. Kết quả: Tổng số 21 Bệnh nhân (BN) (17 nam và 4 nữ) được thực hiện kỹ thuật này. Tuổi trung bình của BN là 58 tuổi. Thời gian phẫu thuật trung bình là 264 phút (210 - 480 phút). Lượng máu mất trung bình 168 ml (100 - 210 ml). Thời gian nằm viện trung bình là 9,42 ngày ( 8 - 16 ngày). Có 2 trường hợp xì miệng nối (9,5%) và được điều trị bảo tồn. Tỉ lệ bờ mặt cắt đạt được R0 là 100%. Có 2 trường hợp CRM (+) sau mổ (9,5%). Số lượng hạch nạo vét được trung bình là 12,34 hạch (9 - 22 hạch). Kết luận: PTNS cắt toàn bộ mạc treo trực tràng qua ngã hậu môn có thể thực hiện an toàn với kết quả tốt về mặt ung thư học. Phẫu thuật đặc biệt có lợi cho các BN có khung chậu hẹp hay béo phì. Từ khóa: Ung thư trực tràng, phẫu thuật nội soi, cắt toàn bộ mạc treo trực tràng ngã hậu môn.

Our experience with transanal total mesorectal excision (TaTME) procedures in middle and distal rectal tumors

2020 ◽  
Vol 99 (3) ◽  
pp. 124-130
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Transanal Total Mesorectal Excision ◽  
Rectal Tumors ◽  
Mesorectal Excision ◽  
Permanent Colostomy ◽  
Conversion To Open Surgery ◽  
Distal Localization

Introduction: Transanal total mesorectal excision (TaTME) is a relatively new approach in surgical treatment of rectal cancer. There are no clear indications when to choose this strategy. It is a technically demanding procedure for the surgeon with a long learning curve, which should also be taken into account in evaluation of this method. The results of both oncological and postoperative complications must be properly evaluated to explore the benefit of TaTME. The aim of this study is to assess the potential benefit of TaTME compared to other alternatives in middle and distal rectal tumors. Methods: Retrospective evaluation of patients undergoing TaTME procedure performed by one team of surgeons between October 2014 and June 2019. The authors analyzed demographic indicators of the group of patients, tumor characteristics, specimen quality, early postoperative complications and the possibility of stoma reversal. Results: A total of 93 patients underwent TaTME procedure for middle and distal rectal cancer. Mean BMI was 27.6 (4.8). T3 or T4 tumor was found in 73 (78.5%) patients, 68 (73.1%) patients had positive lymph nodes and 12 (12.9%) patients were treated for synchronous metastatic rectal cancer. Neoadjuvant therapy was used in 80 (86%) patients. Conversion to open laparotomy was necessary in one case (1%). Stapled anastomosis was performed in 37 (39.7%) cases, handsewn in 56 (60.2%). A positive circumferential resection margin (CRM) was found in 10 (10.7%) cases. Distal resection margin (DRM) was positive in 3 (3.2%) patients. Pathological analysis showed a complete mesorectum in 18 patients (19.4%), nearly complete in 39 (41.9%) and an incomplete mesorectum in 36 (38.7%). Complications in the first 30 days after primary surgery were observed in 38 (40.8%) patients, mainly for anastomotic leak (19 patients, 20.4%). Reoperation was required in 7 (7.5%) patients. Permanent colostomy had to be performed in 4 (4.3%) cases. No patient died after surgery. Conclusion: In a selected group of patients it is possible to perform resection using this approach with acceptable postoperative morbidity and quality of the specimen. We used TaTME procedure in patients expected to have difficult TME due to obesity, size and distal localization of tumor. The incidence of conversion to open surgery was very low. Further studies for long term oncological outcomes are needed.

Új távlatok a végbélrák sebészetében: Transanalis teljes mesorectum excisio. Kezdeti eredményeink

2018 ◽  
Vol 159 (1) ◽  
pp. 16-22 ◽  
Author(s):  
Géza Papp ◽  
Balázs Bánky ◽  
Miklós Lakatos ◽  
Imre Svastics ◽  
Ákos Burány ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Perioperative Complications ◽  
Technical Problem ◽  
Case Series ◽  
Cancer Surgery ◽  
Laparoscopic Technique ◽  
Rectal Cancer Surgery ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision

Abstract: Introduction: Colorectal cancer is the second most frequent cause of oncologic mortality. Its key prognostic factors are operability and surgical quality. Total mesorectal excision is the gold standard of rectal cancer surgery, however, it is hardly achievable with the laparoscopic technique in a number of cases due to anatomical issues. Transanal total mesorectal excision (TaTME) is a new operative concept, which may address this technical problem. Aim: We aimed to present the initial Hungarian experiences with the new technique. Method: Retrospective analysis of clinical data of the first year case series at two Hungarian centers initiating the technique. Results: A total of 17 transanal total mesorectal excision (TaTME) operations were performed at two centers. Major perioperative complications happened in two cases. There was no 30-day mortality. Conclusions: Early Hungarian experiences with transanal total mesorectal excision (TaTME) give hope of a brand new era of rectal cancer surgery. Orv Hetil. 2018; 159(1): 16–22.

scholarly journals Quality Indicators of Transanal Total Mesorectal Excision (TaTME) for Rectal Cancer

2021 ◽  
Vol 41 (04) ◽  
pp. 411-418
Author(s):  
María Labalde Martínez ◽  
Alfredo Vivas Lopez ◽  
Juan Ocaña Jimenez ◽  
Cristina Nevado García ◽  
Oscar García Villar ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Quality Indicators ◽  
Resection Margin ◽  
Surgical Techniques ◽  
Transanal Total Mesorectal Excision ◽  
Anal Margin ◽  
Mesorectal Excision ◽  
American Society ◽  
Laparoscopic Tme

Abstract Introduction Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods A cohort prospective study with 50 (14 female and 36 male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the external anal margin) between the two groups. The rates of: postoperative morbidity (TaTME: 35%; LaTME: 30%; p = 0.763); mortality (0%); anastomotic leak (TaTME: 10%; LaTME: 13%; p = 0.722); wound infection (TaTME: 0%; LaTME: 3.3%; p = 0.409); reoperation (TaTME: 5%; LaTME: 6.6%; p = 0.808); and readmission (TaTME: 5%; LaTME: 0%; p = 0.400), as well as the length of the hospital stay (TaTME: 13.5 days; LaTME: 11 days; p = 0.538), were similar in both groups. There were no statistically significant differences in the rates of positive circumferential resection margin (TaTME: 5%; LaTME: 3.3%; p = 0.989) and positive distal resection margin (TaTME: 0%; LaTME: 3.3%; p = 0.400), the completeness of the TME (TaTME: 100%; LaTME: 100%), and the number of lymph nodes harvested (TaTME: 15; LaTME: 15.5; p = 0.882) between two groups. Conclusion Transanal total mesorectal excision is a safe and feasible surgical procedure for middle/lower-third rectal cancer.

scholarly journals Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis

2018 ◽  
Vol 7 (11) ◽  
pp. 448 ◽  
Author(s):  
Mateusz Rubinkiewicz ◽  
Agata Czerwińska ◽  
Piotr Zarzycki ◽  
Piotr Małczak ◽  
Michał Nowakowski ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Operative Time ◽  
Resection Margin ◽  
Meta Analysis ◽  
Laparoscopic Approach ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Major Complications ◽  
Anterior Rectal Resection

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31–0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.

scholarly journals Clinical Status and Future Prospects of Transanal Total Mesorectal Excision

2022 ◽  
Vol 11 ◽  
Author(s):  
Zichao Guo ◽  
Xiaopin Ji ◽  
Shaodong Wang ◽  
Yaqi Zhang ◽  
Kun Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Resection Margin ◽  
Clinical Status ◽  
Radical Resection ◽  
Low Rectal Cancer ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Promising Alternative ◽  
Novel Approach

Low rectal cancer has always posed surgical challenges to gastrointestinal surgeons. Transanal total mesorectal excision (taTME) is a novel approach to radical resection for low rectal cancer. Compared with conventional laparoscopic TME (laTME), taTME is relevant to the benefits of better vision of the mesorectal plane, feasibility of operating in a narrow pelvis, and exact definition of distal resection margin, which may lead to a higher possibility of free circumferential resection margin, better quality of TME specimen, and lower conversion rate. Although there are concerns about its long-term oncological outcomes and complex learning curve, taTME is a promising alternative for rectal cancer. In this review, we discuss the application status and prospects of taTME.

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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