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

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.

EP.TU.693A rare case of anal melanoma: An entity to be aware of

Aims Anal melanoma is a rare but aggressive malignancy representing a small percentage anorectal cancers. We report a rare case incidentally detected during bowel screening. Methods A 74-year-old female presented for endoscopy after a positive qFIT. She was asymptomatic. During endoscopy, perianal examination revealed a jet black naevus of approximately 3x3cm from 9 to 12’O clock position, overlying the perianal body, involving anal margin to the posterior vagina. General physical, abdominal and rectal examinations were unremarkable. During colonoscopy, a benign polyp was removed from the sigmoid colon. She underwent examination of rectum and vagina under general anaesthetic, and incisional biopsies were obtained. Histopathology confirmed an invasive, superficial spreading malignant melanoma, with a Breslow thickness of 1.5mm and Clark Level IV invasion. Staging CT scans did not reveal metastasis. Following loco-regional MDT discussion, a combined colorectal and plastic surgery was offered. She underwent wide local excision from the posterior vaginal fourchette to the anal canal, bilateral perforator flap reconstruction, and defunctioning sigmoid loop colostomy. Results There were no intraoperative complications. She recovered well post-operatively. After histopathology, her tumour was staged as pT2b, N0, M0. She did not require further treatment post-operatively as per MDTdiscussion. No disease recurrence has been detected yet with 30 months follow up, and she is awaiting reversal of colostomy. Conclusions Prognosis is generally poor in anal melanoma. This case report adds to the limited literature and emphasizs that despite no consensus on management, early detection and surgical resection offers the best chance for favorable outcomes.

Efficacy Comparison and Safety Analysis of Radical Resection of Sigmoid Colon Cancer Based on Different Cancer Locations

Background: Sigmoid colon cancer is a common type of colon cancer; it refers to tumor lesions occurring in the segment approximately 16 cm to 50 cm from the anal margin. Currently, surgical resection is the most effective treatment for non-metastatic sigmoid colon cancer. Therefore, to more accurately standardize colon cancer surgery, we classified the sigmoid colon into distal and proximal segments. This study compares and analyzes the intraoperative situation, postoperative pathology and safety of radical resection of sigmoid cancer in different locations from different aspects. Result: The patients with sigmoid colon tumor can be divided into distal group (16-30cm from the anus) and proximal group (31-50cm from the anus) according to the distance between the tumor and the anal margin. Conclusion: The patients in the distal group using stapler for intestinal anastomosis and anal decompression tube were significantly more than those in the proximal group. For the ligation of the inferior mesenteric artery, high ligation was usually used or the left colic artery was usually preserved in the distal group, and the superior rectal artery was usually retained in the proximal group. The incidence of postoperative complications in the distal group was higher than that in the proximal group, but there was no significant difference between the two groups.

Efficacy comparison and safety analysis of radical resection of sigmoid colon cancer based on different cancer locations

Background: Sigmoid colon cancer is a common type of colon cancer; it refers to tumor lesions occurring in the segment approximately 16 cm to 50 cm from the anal margin. Currently, surgical resection is the most effective treatment for non-metastatic sigmoid colon cancer. Therefore, to more accurately standardize colon cancer surgery, we classified the sigmoid colon into distal and proximal segments. This study compares and analyzes the intraoperative situation, postoperative pathology and safety of radical resection of sigmoid cancer in different locations from different aspects. Result: The patients with sigmoid colon tumor can be divided into distal group (16-30cm from the anus) and proximal group (31-50cm from the anus) according to the distance between the tumor and the anal margin. Conclusion: The patients in the distal group using stapler for intestinal anastomosis and anal decompression tube were significantly more than those in the proximal group. For the ligation of the inferior mesenteric artery, high ligation was usually used or the left colic artery was usually preserved in the distal group, and the superior rectal artery was usually retained in the proximal group. The incidence of postoperative complications in the distal group was higher than that in the proximal group, but there was no significant difference between the two groups.

Nomogram for Benign Anastomotic Stricture After Surgery for Colorectal Cancer

Background Benign anastomotic stricture remains among the most prevalent complications following surgery for colorectal cancer, albeit its incidence is very low. Objective This study is aimed at identifying risk factors of anastomotic stricture as well as generating an effective nomogram for the stricture. Design: This is a retrospective study. Setting: This study was conducted from January, 2015 to December, 2019 in a single tertiary center with colorectal cancer. Patients: A total of 117 colorectal patients after surgery without recurrence including 39 with anastomotic stricture (the distance between anastomotic site and anal margin < = 20 cm) and 78 without the stricture were enrolled in this study. Main outcome measures: Their clinical and pathological data were collected. Multiple logistic regression analysis was conducted for identifying risk factors for anastomotic stricture, and the nomogram prediction model was generated. Results Multivariate analysis of the primary cohort led to identification of LCA (left colon artery) preservation (OR, 0.074; P = 0.0015), protective stoma (OR, 5.353; P = 0.012), anastomotic leakage (OR, 12.027; P = 0.005), and anastomotic distance (OR, 7.578; P = 0.012) as independent risk factors for anastomotic stricture. The following predictive model was derived: Logit (anastomotic stricture) = 0.074* LCA + 5.353* Protective stoma + 12.027* Anastomotic leakage + 7.578* Anastomotic distance. Assessment of the predictive model revealed that the area under curve (AUC) was 0.871, while the cutoff value was 15.444, with a sensitivity of 64.1% and a specificity of 94.8%. Limitations: A retrospective and case-controlled design with a small sample size from one single center is the main Limitation. Conclusions LCA preservation, protective stoma, anastomotic leakage, and anastomotic distance may affect the occurrence of anastomotic stricture following surgery for colorectal cancer. The nomogram model generated in the present study can be valuable in prediction of anastomotic stricture. Registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR 2100043775).

Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients

(1) There is evidence of the embryological, anatomical, histological, genetic and immunological differences between right colon cancer (RCC) and left colon cancer (LCC). This research has the general objective of studying the differences in outcome between RCC and LCC. (2) A longitudinal analytical study with prospective follow-up of the case–control type was conducted from 1 January 2010 to 31 December 2017 including 398 patients with 1:1 matching, depending on the location of the tumor. Inclusion criteria: programmed colectomies, 15 cm above the anal margin, adults and R0 surgery. (3) Precisely 6.8% of the exitus occurred in the first 6 months of the intervention. At 6 months, patients with LCC presented a mean survival of 7 months higher than RCC (p = 0.028). In the first stages, it can be observed that most of the exitus are for patients with RCC (stage I p = 0.021, stage II p = 0.014). In the last stages, the distribution of the deaths does not show differences between locations (stage III p = 0.683, stage IV p = 0.898). (4) The results show that RCC and LCC are significantly different in terms of evolution, progression, complications and survival. Patients with RCC have a worse prognosis, even in the early stages of the disease, due to more advanced N stages, larger tumor size, more frequently poorly differentiated tumors and a greater positivity of lymphovascular invasion than LCC.

Efficacy Comparison and Safety Analysis of Radical Resection of Sigmoid Colon Cancer Based on Different Cancer Locations

Background: Sigmoid colon cancer is a common type of colon cancer; it refers to tumor lesions occurring in the segment approximately 16 cm to 50 cm from the anal margin. Currently, surgical resection is the most effective treatment for non-metastatic sigmoid colon cancer. Therefore, to more accurately standardize colon cancer surgery, we classified the sigmoid colon into distal and proximal segments. This study compares and analyzes the intraoperative situation, postoperative pathology and safety of radical resection of sigmoid cancer in different locations from different aspects. Result: The patients with sigmoid colon tumor can be divided into distal group (16-30cm from the anus) and proximal group (31-50cm from the anus) according to the distance between the tumor and the anal margin. Conclusion: The patients in the distal group using stapler for intestinal anastomosis and anal decompression tube were significantly more than those in the proximal group. For the ligation of the inferior mesenteric artery, high ligation was usually used or the left colic artery was usually preserved in the distal group, and the superior rectal artery was usually retained in the proximal group. The incidence of postoperative complications in the distal group was higher than that in the proximal group, but there was no significant difference between the two groups.

SURGICAL DIFFICULTY AND PELVIMETRY IN RECTAL CANCER. IS IT USEFUL?

INTRODUCTION Different difficulty factors have been described in rectal cancer surgery as BMI, male gender, tumor height, neoadjuvant treatment or narrow pelvis. Pelvimetry is not a routine preoperative study in rectal cancer. MATERIAL AND METHODS Retrospective observational study in 228 patients. Operative time was evaluated as a difficult surgical parameter and its relationship with pelvimetric variables was studied. RESULTS Our average operative time was 255,4 ± 65,8 minutes. Significant results were found with regard to patients’ BMI, distance to the anal margin, type of approach, need for neoadjuvant therapy and the following pelvimetry parameters. In the univariate analysis, the parameters were pubis height, pelvis depth, angle of the right levator in coronal plane, the ratio of the pelvis inlet diameter with respect to its depth, the ratio of the angle promontory-S3-coccyx with respect to the angle S3-coccyx-lower border of the pubis and the ratio of the area of the mesorectum to the area of the pelvis in the sagittal plane. In multivariate analysis, the variables that most influenced the surgical time were the type of approach, the BMI, the location of the tumor, the intraoperative complications and the ratio of the mesorectum area to the area of the pelvis in the sagittal plane. CONCLUSION Pelvimetry is a simple tool that completes preoperative studies and also obtains better surgical planning in complex pelvises.

Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

Despite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

Hyperuricemia May Affect the Healing of Anastomosis in Dixon Surgery for Rectal Cancer: A Retrospective Study

Background：The impact of Hyperuricemia (HUA) on Dixon surgery is rarely reported. Anastomotic leakage (AL) is the main serious complication in Dixon surgery. We discussed the relationship between HUA and AL. Our aim was to identify these factors to provide intervention measures for clinical practice.Methods：The clinical data of 1147 patients who underwent Dixon operation for rectal cancer in the Second Affiliated Hospital of Fujian Medical University from January 2009 to December 2018 were retrospectively analyzed. Rank sum test was used for measurement data, and χ2 test was used for counting data. In univariate analysis, significant variables (P < 0.05) were used for multivariate analysis, and multivariable logistic regression was used to examine their independent roles. All tests were 2-sided, P<0.05 was considered statistically significant.Results：A total of 1147 patients with rectal cancer undergoing Dixon operation were included in the study, including 153 patients with HUA and 994 patients with normal uric acid (UA). The AL was 148 cases (14.9%) in UA group and 37 cases (24.2%) in HUA group. There was significant difference in AL (P = 0.006). The influence of HUA (P = 0.006), Tumor distance from the anal margin (TD) (P = 0.024) and preoperative chemoradiotherapy (PCT) (P = 0.040) on AL were significantly different. Logistic analysis showed that HUA (P = 0.021) and TD (P = 0.014) had significant effects on AL. In rectal cancer group with HUA, there were significant differences in the effects of male (P = 0.035), body mass index (BMI) (P = 0.017) and PCT (P = 0.013) on AL. Logistic analysis showed that there were significant differences between male (P = 0.001) and PCT (P = 0.004) on AL.Conclusions：HUA is an independent risk factor of AL in Dixon operation for rectal cancer. In patients with HUA undergoing Dixon operation, gender, BMI and PCT have significant difference on AL. Male and PCT are independent risk factors of AL.