Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer

Lacy, Francisco B. de; Laarhoven, J.J.E.M. van; Pena, Romina; Arroyave, María Clara; Bravo, Raquel; Cuatrecasas, Míriam; Lacy, Antonio M.

doi:10.1007/s00464-017-5944-8

Cited by 79 publications

(45 citation statements)

References 25 publications

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“…reported that the traditional surgical approaches may lead to a greater rate of positive CRMs for tumors less than 3cm from the dentate line [24]. Ina study of 186cases, Lacy found positive CRMs present in 8.1% of patients [25]. Theoretically, a more meticulous dissection as allowed because of better visualization by the Ta-TME approach may be very helpful for achieving a negative CRM for these distal rectal tumors; indeed, this was veri ed by Denost etal.…”

Section: Discussionmentioning

confidence: 86%

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

Wang

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 86%

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

Wang

et al. 2020

Preprint

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“…Since then, the feasibility and safety of this surgery has been reported by many case studies with acceptable short‐term outcomes . Most recently, de Lacy's group reported the pathological results of 186 constitutive cases with mid and low rectal cancer . Complete TME was achieved in 95.7%, and overall positive CRM (≤1 mm) and distal resection margin (DRM) (≤1 mm) were 8.1% and 3.2%, respectively.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Recent updates in the surgical treatment of colorectal cancer

Matsuda

Yamashita

Hasegawa

et al. 2018

Annals of Gastroent Surgery

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Because of recent advances in medical technology and new findings of clinical trials, treatment options for colorectal cancer are evolutionally changing, even in the last few years. Therefore, we need to update the treatment options and strategies so that patients can receive optimal and tailored treatment. The present review aimed to elucidate the recent global trends and update the surgical treatment strategies in colorectal cancer by citing the literature published in the last 2 years, namely 2016 and 2017. Although laparoscopic surgery is still considered the most common approach for the treatment of colorectal cancer, new surgical technologies such as transanal total mesorectal excision, robotic surgery, and laparoscopic lateral pelvic lymph node dissection are emerging. However, with the recent evidence, superiority of the laparoscopic approach to the open approach for rectal cancer seems to be controversial. Surgeons should notice the risk of adverse outcomes associated with unfounded and uncontrolled use of these novel techniques. Many promising results are accumulating in preoperative and postoperative treatment including chemotherapy, chemoradiotherapy, and targeted therapy. Development of new biomarkers seems to be essential for further improvement in the treatment outcomes of colorectal cancer patients.

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“…In this context, taTME has shown higher rates of sphincter preservation than laparoscopy alone [27]. Table 1 summarizes the initial experience of seven case series [28][29][30][31][32][33] of patient treated with taTME for rectal cancer. These case series include 26 to 720 patients.…”

Section: Tatme For Cancermentioning

confidence: 99%

Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision

Chevallay

Meyer

Wassmer

et al. 2019

Curr Colorectal Cancer Rep

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Purpose of Review The access of the low rectum is a surgical challenge and, in case of cancer, the outcome of the patient depends on the quality of the surgery. The transanal total mesorectal excision (taTME) is a surgical technique with a combined abdominal and perineal approach. We review the literature for technical aspect of taTME as well as comparisons with other techniques. Recent Findings Comparison with laparoscopic total mesorectal excision and taTME was summarized in a meta-analysis which showed better oncological results with lower circumferential margin involvement and better completeness of the mesorectum. Summary TaTME is a safe approach. All steps of the intervention are well described and should be followed as numerous pitfalls exist. When compared with laparoscopic or robotic TME, the taTME showed to be safe with similar oncological results. Patients known to be difficult, male, obese, with a narrow pelvis, should be considered for the taTME approach.

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Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer

Cited by 79 publications

References 25 publications

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

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

Recent updates in the surgical treatment of colorectal cancer

Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision

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