Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma

Velthuis, Simone; Nieuwenhuis, D.H.; Ruijter, T. Emiel G.; Cuesta, Miguel A.; Bonjer, H. Jaap; Sietses, C.

doi:10.1007/s00464-014-3636-1

Cited by 171 publications

(173 citation statements)

References 19 publications

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“…Although more studies are required to be confirmed the above findings, the comparative results published by Velthuis et al [7] , indicated that TaTME may be associated to a significantly higher rate of completeness of mesorectal excision, compared to laparoscopic TME.…”

Section: Oncological Outcomesmentioning

confidence: 74%

“…Results from four studies [7,11,12,115] , addressed positive CRM in 10 out of 136 patients (7.3%), while all studies, except two [103,113] , reported a mean number of retrieved lymphnodes equal to or greater to 12.…”

Section: Oncological Outcomesmentioning

confidence: 99%

“…The Dutch TME trial [5] confirmed the above results, clearly stating an increased risk of local tumor recurrence for patients who had undergone a potentially curative procedure with incomplete mesorectal excision, as compared to patients in whom the specimen showed a completely resected mesorectum [6] . Laparoscopy offers better visualization of the pelvic cavity and therefore facilitates mobilization of the rectum [7] . Although laparoscopic TME is a standardized and reproducible procedure [8] , it can be proved a technically difficult operation [9] .…”

Section: Introductionmentioning

confidence: 99%

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Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

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Section: Oncological Outcomesmentioning

confidence: 74%

Section: Oncological Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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“…Postoperative outcomes and oncological results of taTME and laTME were reported by several retrospective and comparative studies to be similar. Nevertheless, others have also reported specific intraoperative complications observed during taTME, such as urethral or bladder injury and rectal or vaginal perforation [11,12,13,14,29,30,31]. Despite that, in our first 25 cases with middle or lower third rectum cancer, we managed to avoid severe operative complications most likely due to previous training and very thorough preparation.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, a new kind of minimally invasive surgical procedure, i.e. transanal TME (taTME), has rapidly become of interest in minimally invasive surgery research [11,12,13,14]. Besides conventional laparoscopic surgery, taTME has been introduced in order to ease the technical aspects of mesorectal excision from the bottom towards the pelvis.…”

Section: Introductionmentioning

confidence: 99%

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

et al. 2019

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Background: The novel surgical procedure transanal total mesorectal excision (taTME) has rapidly become an interest of research in order to overcome the shortcomings of laparoscopic surgery in the treatment of middle and low rectal cancer. taTME is a new natural orifice transluminal endoscopic surgery modality combining three rectal surgery techniques. Methods: A retrospective clinical study was conducted in a single centre for a period of 3 years, and herein we report on our first 25 taTME procedures in patients with middle and lower third rectal adenocarcinoma. Results: The main demographics were evaluated. The mean age of patients was 64 ± 12 years. There were predominantly males (72%) and 7 female patients (28%) with an average body mass index of 29 ± 4.8 kg/m². High blood pressure, obesity, chronic heart insufficiency, chronic atrial fibrillation, and diabetes mellitus were commonly diagnosed in all patients. A circumferential resection margin >1 mm was achieved in 16% (n = 4), >2 mm in 40% (n = 10), and >3 mm in 44% (n = 11) of operated patients. The average CRM was 1.8 ± 0.9 cm. In 24% of cases, the distance of a tumour from the mesorectal fascia (MRF) was <1 mm; meanwhile, for 76% of patients, the tumour margin was >1 mm from the MRF. Recovery to flatus was 3 ± 1 days. The average length of hospital stay was 11 ± 3 days. The overall postoperative morbidity was 8%, i.e. one (4%) complication classified as Clavien-Dindo degree I and one (4%) major (IIIb) complication. Subsequently, all patients successfully recovered and were discharged from hospital. During the follow-up period no cancer recurrence was observed. Conclusion: Our results nicely demonstrate that taTME can be safely performed with acceptable perioperative complications in patients with middle or lower third rectal cancer. In addition, the perioperative morbidity is also acceptable. However, taTME remains a technically highly demanding operation but is feasible and safe after the appropriate experience is gained. Nevertheless, larger multi-centre prospective randomised studies are ongoing to confirm the safety and to verify oncological results when compared to laparoscopic rectal surgery.

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Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment

Takemasa

Hamabe

Miyo

et al. 2022

Annals of Gastroent Surgery

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In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard‐of‐care to the latest findings to help optimize treatment strategy.

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Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma

Abstract: Transanal TME appears associated with a significant higher rate of completeness of the mesorectum. Further studies are necessary to evaluate this novel technique.

Cited by 171 publications

References 19 publications

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Transanal Total Mesorectal Excision: Is There a Real Advantage? The Baltic View

Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment

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