Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short‐term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non‐transanal laparoscopic TME. However this association was lost in the mixed‐effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P = 0.39 and OR 2.11, 0.79–5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P < 0.001) and male gender (OR 2.29, 1.52–3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%. Conclusion This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.

Introduction The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre‐operative imaging. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post‐treatment MRI restaging (yMRI) and final pathological staging. Results Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post‐treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T‐stage, N‐stage, or AJCC status were each graded as ‘fair’ only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion The reported pCR rate of 10% highlights the potential for non‐operative management in selected cases. The limited strength of agreement between basic conventional post‐chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.

Background Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. Methods Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30‐day major complication rate, defined as Clavien‐Dindo grade III‐V. Results Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27–2.11, P < 0.001). Conclusions Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection.

ВведениеСреди злокачественных новообразований ко-лоректальный рак занимает четвертую позицию по частоте. Ежегодно регистрируют около 1,2 млн но-вых случаев заболевания. Более чем у половины за-болевших развивается метастатическое поражение печени [1][2][3] и без соответствующего лечения лишь 0-2% из них преодолевают 5-летний рубеж выживаемости. В последнее десятилетие намети-лась положительная тенденция в лечении пациен-тов с метастатическим колоректальным раком (мКРР) печени. Современные режимы лекарствен-ной терапии, включающие иринотекан, оксали-платин, цетуксимаб и бевацизумаб, обеспечивают уровень ответа до 50-80%, повышают медиану вы-живаемости при нерезектабельном поражении до 12-24 мес и позволяют перевести опухоль из раз-ряда нерезектательных в резектабельные у 5-15% больных [4, 5]. Отделение хирургии печени, желчных путей и поджелудочной железы (руководитель -д.м.н. Г.а. Шатверян) российского научного центра хирургии им. акад. Б.в. петровского, москва Введение. Онкологическая эффективность радиочастотной абляции (рЧа) и ее место в структуре комбинированного лечения остаются предметом дискуссий на онкологических форумах и в публикуемых в мировой литературе исследо-ваниях. Цель работы -изучение хирургических и онкологических результатов лечения пациентов с метастатическим колоректальным раком печени методом рЧа в структуре комбинированного подхода. Материал и методы. использован проспективный анализ результатов лечения 76 пациентов с метастатическим колоректальным раком печени с примене-нием метода рЧа за период с 2004 по 2013 г. проведен унивариантный и мультивариантный анализ общей выживаемости. Результаты. Отрицательное влияние на общую 5-летнюю выживаемость по результатам унивариантного анализа оказы-вают локализация первичной опухоли в прямой кишке (36,2 и 7,2%; p=0,021), билобарное метастатическое поражение печени (35,9 и 15,4%; p=0,068); размер метастазов более 5 см (27,4% и 0; p=0,091), уровень CAE выше 4 норм (26,7 и 11,4%; p=0,09), выполнение рЧа одним из этапов двухэтапного хирургического вмешательства на печени (23,3 и 26,0%; p=0,09). Вывод. рЧа является эффективным методом локального противоопухолевого воздействия при метастатическом колоректальном раке. на отдаленную выживаемость после рЧа влияют размер коагулируемых метастазов, объем мета-статического поражения, уровень ракового эмбрионального антигена, выполнение абляции в рамках двухэтапного хирур-гического лечения. Ключевые слова: метастазы колоректального рака в печень, радиочастотная абляция. Radiofrequency ablation in combined treatment of metastatic colorectal liver cancerdepartment of Liver, Biliary and pancreatic Surgery (head -G.A. Shatveryan), petrovsky russian research Center of Surgery, moscow Aim. to study surgical and oncological outcomes in patients with metastatic colorectal liver cancer who underwent radiofrequency ablation in the structure of combined approach. Material and methods. it is a prospective analysis of treatment of 76 patients with metastatic colorectal liver cancer who underwent rFA for the period 2004-2013....

Isolated pancreatic metastases of renal cell carcinoma can occur in decades after nephrectomy. Therefore, lifelong follow-up is necessary. Pancreatectomy for focal lesion is associated with good long-term outcome.