Transanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers

Zuhdy, Mohammad; Elmore, Ugo; Shams, Nazem; Hegazy, Mohamed A.; Roshdy, Sameh; Eldamshety, Osama; Metwally, Islam H.; Rosati, Riccardo

doi:10.1089/lap.2019.0828

Cited by 9 publications

(18 citation statements)

References 35 publications

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“…After exclusion, 8 relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. The eight studies including 471 patients with middle or low rectal cancer.…”

Section: Resultsmentioning

confidence: 99%

Total mesorectal excision laparoscopic versus transanal approach for rectal cancer: A systematic review and meta-analysis

Bianco

Lanzafame

Piazza

et al. 2022

Annals of Medicine &Amp; Surgery

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Introduction Total mesorectal excision (TME) performed for the first time by Held through an open approach, it has become the standard technique for the surgical treatment of rectal cancer. The aim the of this meta-analysis is to compare the outcomes provided by TaTME than LaTME. Material and methods In this meta-analysis, we included all comparative studies, prospective and retrospective, which addressed in low and middle rectal cancer, a comparison between TaTME and LaTME. A search was performed through MEDLINE and Cochrane Database. 846 records were identified. Results Eight relevant studies have been included in this meta-analysis. The studies were from France, Russia, USA, Netherlands, Taiwan, Egypt. The eight studies including 471 patients with middle or low rectal cancer. Conclusion The meta-analysis confirmed safety of TaTME for low and middle rectal cancer. TaTME can lead to a high quality of rectal cancer resection specimen.

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Section: Resultsmentioning

confidence: 99%

Total mesorectal excision laparoscopic versus transanal approach for rectal cancer: A systematic review and meta-analysis

Bianco

Lanzafame

Piazza

et al. 2022

Annals of Medicine &Amp; Surgery

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“…An RCT from China evaluated pathological outcomes after t-TME (n=128) versus laparoscopic TME (n=133) and did not report any difference, a positive CRM was detected in 2 cases in each group ( 99 ). A prospective, non-randomized, comparative analysis of 58 cases from two centers reported comparable oncological outcomes between t-TME and laparoscopic conventional TME ( 100 ). The largest single-arm study to date includes results from the international t-TME registry, which noted t-TME to be an oncologically safe and effective technique that has acceptable short-term clinical outcomes ( 101 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer

et al. 2022

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IntroductionThere are standard treatment guidelines for the surgical management of rectal cancer, that are advocated by recognized physician societies. But, owing to disparities in access and affordability of various treatment options, there remains an unmet need for personalizing these international guidelines to Indian settings.MethodsClinical Robotic Surgery Association (CRSA) set up the Indian rectal cancer expert group, with a pre-defined selection criterion and comprised of the leading surgical oncologists and gastrointestinal surgeons managing rectal cancer in India. Following the constitution of the expert Group, members identified three areas of focus and 12 clinical questions. A thorough review of the literature was performed, and the evidence was graded as per the levels of evidence by Oxford Centre for Evidence-Based Medicine. The consensus was built using the modified Delphi methodology of consensus development. A consensus statement was accepted only if ≥75% of the experts were in agreement.ResultsUsing the results of the review of the literature and experts’ opinions; the expert group members drafted and agreed on the final consensus statements, and these were classified as “strong or weak”, based on the GRADE framework.ConclusionThe expert group adapted international guidelines for the surgical management of localized and locally advanced rectal cancer to Indian settings. It will be vital to disseminate these to the wider surgical oncologists and gastrointestinal surgeons’ community in India.

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“…Oncological outcomes, particularly long-term local disease control in low-lying rectal cancer, depend on obtaining a high-quality TME specimen with an intact mesorectum with adequate CRM [ 49 , 50 ]. Some particular conditions can increase the complexity of transabdominal TME in certain cases; per example, visualization can be complex in an obese patient with a bulky tumor and a narrow pelvis, also pelvic bone parameters such as sacral depth or intertuberous diameter [ 11 ], and the incline angle of pelvic floor muscle may provide an anatomical parameter that predicts TME difficulty [ 51 ] leaving limited space for adequate pelvic dissection.…”

Section: Surgical Managementmentioning

confidence: 99%

“…Sylla et al [ 60 ] reported urethral and other urologic injuries during TaTME. The low rectal cancer development program International TaTME registry [ 50 , 61 ] reported a 0.8% incidence, 34 urethral, 2 ureteral, and 3 bladder injuries were reported. The urethral repair complication rate was 26%, with 9% of failed urethral repair requiring permanent urinary diversion; in patients with successful repair, 18% reported persistent urinary dysfunction.…”

Section: Surgical Managementmentioning

confidence: 99%

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Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Transanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers

Cited by 9 publications

References 35 publications

Total mesorectal excision laparoscopic versus transanal approach for rectal cancer: A systematic review and meta-analysis

Total mesorectal excision laparoscopic versus transanal approach for rectal cancer: A systematic review and meta-analysis

Clinical Robotic Surgery Association (India Chapter) and Indian rectal cancer expert group’s practical consensus statements for surgical management of localized and locally advanced rectal cancer

Surgical Treatment of Low-Lying Rectal Cancer: Updates

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