Natural orifice transluminal endoscopic surgery for colorectal cancer

Introduction: Transanal total mesorectal (TaTME) is an emerging surgical technique for mid-low rectal cancer. This study investigated the double-team TaTME on the short-term morbidity, quality of surgical specimens, and functional and oncologic outcomes by comparing them with the single-team TaTME. Methods: We analyzed the surgical results of 72 patients (n = 40 double-team TaTME, n = 32 single-team TaTME) with mid-low rectal cancer who treated for mid-low rectal cancer with single-team TaTME or double-team TaTME. Results: The operative time was significantly shorter with a double-team TaTME (180 ± 45 min) than with a single-team TaTME (230 ± 55 min). Also, there were no intraoperative events recorded in both groups. The rate of pre-sacral abscesses complications (grade III) in the double-team (0%) was significantly lower than in the single-team group (3, 9.4%). The proportions of TME grade I, TME grade II, and TME grade III were not significantly different between the single-team and double-team groups. A positive circumferential resection margin (CRM) was not significantly different between the double-team groups (2, 5.0%) and the single-team (3, 9.3%). The mean low anterior resection syndrome (LARS) scores were lower in the double-team group (27 ± 4.5) than in the single-team group (29 ± 3.8) (p = 0.048). Simultaneously, the disease-free survival (DFS) rate was not significantly different between the two groups. Conclusion: The double-team TaTME in treatment of mid-low rectal cancer is effective with the shortness of operative time, the lower rate of the postoperative pre-sacral abscess, and LARS scores, while this method guaranteed the quality of mesorectal specimens and the DFS rate.

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Transanal total mesorectal excision for patients with middle-low rectal cancer in locally advanced stage

2018

Vietnam Journal of Endolaparoscopic Surgery

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Introduction: Patients with middle-low rectal cancer in advanced stage had many difficulties in performing laparoscopic total mesorectal excision (TME), especially in those with narrow pelvis or obese with or without neoadjuvant therapy. We conducted the study of transanal TME (TaTME) for these patients to evaluate the safety and efficacity of this technique. Material and Methods: Prospective study. Patients with middle-low rectal cancer in advanced stage underwent rectal resection with TaTME technique were enrolled. Results: 38 patients including 25 middle and 13 low rectal tumors underwent elective rectal resection by TaTME from March 2015 to September 2018. Male/female ratio: 25/13. Mean age: 58.2 ± 16.4 and BMI: 24.2 ±2.5 kg/m2. Mean operation duration:210 ± 42 minutes. Specimen were removed through abdominal incision in 23 patients and 15 via anus. Anastomoses were performed by hands in 100% patients. The protective ileostomie was performed 100%. One left ureteral burning and postoperative difficulty in voiding, one presacral abscess due to anastomotic fistula and one totally leakage of the anastomose. Good Quirke assessment in 87% patients. The distal resection margins (DRM) was 20 ± 5 mm. Distal resection margins (DRM) were negative in 100% patients and circumferential resection margins (CRM) were positive in one (2.6%) patients. The hospital stay was 6 days. Median follow-up time was 12 months. One patient had local recurrence at 18th months and 1 had liver metastasis at 6th months. Conclusion: TaTME for patients with middle-low rectal cancer in advanced stage is safe and efficacious. However, there is a need for large, multicentric studies to accurately evaluate this technique.

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Natural orifice transluminal endoscopic surgery for colorectal cancer

Cited by 3 publications

References 26 publications

Transvaginal Radical Resection of Rectal Cancer Through Rigid Endoscopy (Rectal Tv-NOTES)

Transvaginal Radical Resection of Rectal Cancer Through Rigid Endoscopy (Rectal Tv-NOTES)

The effectiveness of double team for transanal total mesorectal excision in treatment of mid-low rectal cancer

Transanal total mesorectal excision for patients with middle-low rectal cancer in locally advanced stage

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