Evaluation of laparoscopic-assisted transanal total mesorectal excision (Ta-TME) for locally advanced distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy

Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.

Evaluation of laparoscopic-assisted transanal total mesorectal excision (Ta-TME) for locally advanced distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy

Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups.Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.

The liver-first approach in treatment of rectal cancer patients with synchronous liver metastases

Objective: to evaluate feasibility and short-term results of the liver-first approach in our center.Materials and methods. Retrospective study of prospectively gathered group of patients who were treated in N. N. Blokhin National Medical Research Center of Oncology between 2017 and 2019. Patients with asymptomatic primary tumor located in rectum and rectosigmoid junction with synchronous resectable / borderline resectable metastasis in liver. 22 patients were planned to undergo the liver-first approach. Post-operative morbidity and mortality (Clavien–Dindo) as well as tumor regression grading (Dworak) were evaluated.Results. Of the 17 patients planned to undergo the liver-first strategy, the approach was completed in 15 (88,2 %) patients. The main reason for treatment failure was disease progression. Post-operative morbidity and mortality were 13,3 % and 0 %, respectively.Conclusions. Liver-first approach is justified in two cases: during waiting period after last day of chemoradiotherapy in patients with locally advanced (invasion depth T4a, positive circumferential resection margin, N+ status) mid-to-low rectal cancer and in patients with multiple borderline resectable bilobar liver damage.

Evaluation of laparoscopic-assisted transanal total mesorectal excision(ta-TME) for locally advanced, distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy

BackgroundTo evaluate the use of laparoscopic-assisted transanal, total mesorectal excision (ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.MethodsTwenty male patients（laparoscopic-assisted transanal total mesorectal excision, A group）with difficult pelvic anatomy (narrow pelvis) who were diagnosed as rectal cancer underwent a Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME （LA group）or an open transabdominal TME（OP group）according to age, sex, BMI, distance of tumor from the anal verge, and diameter of the tumor. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. We also analyzed whether operative time could be shortened using a laparoscopically assisted Ta-TME through optimizing the surgical procedure.ResultsWhen comparing Ta-TME（TA group）, laparoscopic transabdominal TME(LA group), and open transabdominal TME（OP group, the respective mean blood loss(100mL, 100mL, 100mL, p=0.335),postoperative hospital stay(9 days,9 days,7 days),number of harvested lymph nodes(7, 6, 7,), positive circumferential resection margin rate(0%, 0%, 5%), rate of pathologic complete response(5%,10%,10%,), and integrity of TME showed no statistical differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time(302 min, 253 min, 135 min),rate preservation of the anal sphincter(100%, 30%, 45%,), and the creation of a protective diverting ileostomy(100%, 30%, 45%, p<0.05 for all).ConclusionThe rate of anal sphincter preservation in the Ta-TME group was considerably greater than the other groups, but the safety of the operation did not differ among the 3 groups. The Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME. We believe that experience and appropriate procedure of the steps of the Ta-TME may lead to a decrease in the operation time.