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PloS One 2023Minimally invasive total mesorectal excision is increasingly being used as an alternative to open surgery in the treatment of patients with rectal cancer. This...
OBJECTIVES
Minimally invasive total mesorectal excision is increasingly being used as an alternative to open surgery in the treatment of patients with rectal cancer. This systematic review aimed to compare the total, operative and hospitalization costs of open, laparoscopic, robot-assisted and transanal total mesorectal excision.
METHODS
This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) (S1 File) A literature review was conducted (end-of-search date: January 1, 2023) and quality assessment performed using the Consensus Health Economic Criteria.
RESULTS
12 studies were included, reporting on 2542 patients (226 open, 1192 laparoscopic, 998 robot-assisted and 126 transanal total mesorectal excision). Total costs of minimally invasive total mesorectal excision were higher compared to the open technique in the majority of included studies. For robot-assisted total mesorectal excision, higher operative costs and lower hospitalization costs were reported compared to the open and laparoscopic technique. A meta-analysis could not be performed due to low study quality and a high level of heterogeneity. Heterogeneity was caused by differences in the learning curve and statistical methods used.
CONCLUSION
Literature regarding costs of total mesorectal excision techniques is limited in quality and number. Available evidence suggests minimally invasive techniques may be more expensive compared to open total mesorectal excision. High-quality economical evaluations, accounting for the learning curve, are needed to properly assess costs of the different techniques.
Topics: Humans; Robotics; Rectal Neoplasms; Proctectomy; Laparoscopy; Hospitalization; Transanal Endoscopic Surgery; Rectum; Treatment Outcome; Postoperative Complications
PubMed: 37506122
DOI: 10.1371/journal.pone.0289090 -
Anticancer Research Aug 2023Transanal total mesorectal excision (TaTME) remains a challenging technique for rectal dissection. This study aimed to evaluate the clinical and oncological outcomes of...
BACKGROUND/AIM
Transanal total mesorectal excision (TaTME) remains a challenging technique for rectal dissection. This study aimed to evaluate the clinical and oncological outcomes of TaTME, compared to those of the laparoscopic TME (LaTME) in rectal cancer.
PATIENTS AND METHODS
Using propensity score-matched analyses, we analyzed retrospective data from 134 consecutive patients with rectal cancer who underwent TaTME or LaTME from January 2011 to June 2020 in our hospital. Clinical and oncological outcomes were evaluated. The primary endpoint was the 2-year local recurrence rate.
RESULTS
Before data analysis, significant group-dependent differences were observed only in the tumor height (p<0.01). After analysis, preoperative patient demographics were similar between the TaTME and LaTME groups. The operative time was significantly shorter in the TaTME group (p=0.02), and the rates of hand-sewn anastomosis and protective loop ileostomy were significantly higher (p<0.01). The TaTME group showed a null conversion to open surgery compared to the LaTME group (5.9%). The postoperative complications, including anastomotic leak, were comparable between the two groups. However, the rate of Clavien-Dindo grade III tended to be lower in the TaTME group (p=0.07). There were no statistically significant differences in terms of pathological findings, and the 2-year local recurrence rate was similar between the two groups (both 5.9%).
CONCLUSION
TaTME based on embryology along the fascia is feasible and seems a safe alternative to LaTME in selected patients with rectal cancer when considering the conversion rate and the operative time.
Topics: Humans; Retrospective Studies; Transanal Endoscopic Surgery; Rectal Neoplasms; Rectum; Laparoscopy; Postoperative Complications; Fascia; Treatment Outcome
PubMed: 37500175
DOI: 10.21873/anticanres.16539 -
International Journal of Surgery Case... Aug 2023Ileorectal fistulas following sigmoid colon vaginoplasty are rare. Reports on the management of the surgical complications of sex reassignment operations among...
INTRODUCTION
Ileorectal fistulas following sigmoid colon vaginoplasty are rare. Reports on the management of the surgical complications of sex reassignment operations among transgender patients are few.
PRESENTATION OF CASE
A 40-year-old patient with a male-to-female sex identity disorder underwent sigmoid vaginoplasty for sex reassignment 4 months prior to presentation. The patient was referred for persistent diarrhea and postoperative lower abdominal pain. Proctoscopy, gastrografin enema, and small bowel enterography revealed rectal anastomotic stenosis and an ileorectal fistula. The prior anastomotic site and ileal rectal fistula were resected, and ileal interposition reconstruction was performed to avoid damaging the blood supply to the artificial vagina. Routine follow-up after the closure of the diverting ileostomy showed no new pathologies.
DISCUSSION
This case highlighted the management of surgical complications after sex reassignment surgery.
CONCLUSION
Ileal interposition was a useful reconstruction method after resecting the colonic anastomotic site to preserve the artificial vagina.
PubMed: 37481975
DOI: 10.1016/j.ijscr.2023.108523 -
Techniques in Coloproctology Nov 2023
Topics: Humans; Colorectal Surgery; Rectum; Transanal Endoscopic Surgery; Digestive System Surgical Procedures; Anastomosis, Surgical; Rectal Neoplasms; Postoperative Complications; Minimally Invasive Surgical Procedures; Anastomotic Leak; Anal Canal
PubMed: 37358670
DOI: 10.1007/s10151-023-02834-x -
Surgical Oncology Aug 2023The aim of this study was to evaluate the long-term surgical and oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer during an...
PURPOSE
The aim of this study was to evaluate the long-term surgical and oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer during an implementation phase on a national level.
METHOD
This is a retrospective review of prospectively recorded data. Registration was initiated by the Danish Colorectal Cancer Group in order to assess the quality of care during the implementation of TaTME in Denmark. Data from four centers were pooled for simultaneous analysis. Short-term data was available from a prior study, and long-term data regarding recurrences, chemotherapy, and mortality was collected.
RESULTS
From August 2016 to April 2019, 115 TaTME procedures were registered. Patients were predominantly male (n = 85, 74%) with mid-rectal (n = 88, 77%) tumors. The overall local recurrence rate was 7.8% (n = 9) of which six patients also had systemic recurrence. Mean long-term follow-up was 59.4 months, and median time to local recurrence was 24.9 months. Local recurrences occurred predominantly among initial implementation cases. The overall mortality rate was 13% (n = 15). Of the 17 patients with recurrence, 35% (n = 6) died and developed either solely distant recurrence (n = 2, 12%) or in combination with local recurrence (n = 4, 24%).
CONCLUSION
We found acceptable long-term oncological results after TaTME during the implementation phase in Denmark. There was an accumulation of local recurrences in the early phase of the study which emphasizes the importance of thorough training and proctoring when starting the approach.
Topics: Humans; Male; Female; Prospective Studies; Postoperative Complications; Transanal Endoscopic Surgery; Rectal Neoplasms; Denmark; Recurrence; Laparoscopy; Treatment Outcome
PubMed: 37356316
DOI: 10.1016/j.suronc.2023.101967 -
The British Journal of Surgery Nov 2023
Topics: Humans; Rectal Neoplasms; Proctectomy; Transanal Endoscopic Surgery; Rectum; Postoperative Complications; Laparoscopy; Treatment Outcome
PubMed: 37311697
DOI: 10.1093/bjs/znad168 -
Surgical Endoscopy Sep 2023Anus-preserving surgery for low rectal cancer has always been a serious difficulty for surgeons. Transanal total mesorectal excision (TaTME) and laparoscopic...
BACKGROUND
Anus-preserving surgery for low rectal cancer has always been a serious difficulty for surgeons. Transanal total mesorectal excision (TaTME) and laparoscopic intersphincteric resection (ISR) are commonly used Anus-preserving surgeries for low rectal cancer. The aim of this study was to compare the clinical use of two surgical methods.
METHODS
A total of 152 patients with low rectal cancer were treated with taTME in 75 cases and ISR in 77 cases. After propensity score matching, 46 patients in each group were included in the study. Perioperative outcomes, anal function scores (Wexner incontinence score) and quality of life scores (EORTC QLQ C30, EORTC QLQ CR38) at least 1 year after surgery were compared between the two groups.
RESULTS
There were no significant differences between the two groups in terms of surgical outcomes, pathological examination of surgical specimens, postoperative recovery, and postoperative complications, except for patients in the taTME group who had their indwelling catheters removed later. Anal Wexner incontinence score was lower in taTME group than ISR group (P < 0.05). On the EORTC QLQ-C30 scale, the physical function and role function scores in the ISR group were lower than those in the taTME group (P < 0.05), while the fatigue, pain symptoms, and constipation scores in the ISR group were higher than those in the taTME group (P < 0.05). On the EORTC QLQ-CR38 scale, the scores of gastrointestinal symptoms and defecation problems in the ISR group were higher than those in the taTME group (P < 0.05).
CONCLUSION
Compared with ISR surgery, taTME surgery is comparable in terms of surgical safety and short-term efficacy, and has better long-term anal function and quality of life. From the perspective of long-term anal function and quality of life, taTME surgery is a better surgical method for the treatment of low rectal cancer.
Topics: Humans; Rectum; Propensity Score; Quality of Life; Transanal Endoscopic Surgery; Rectal Neoplasms; Laparoscopy; Treatment Outcome; Postoperative Complications; Fecal Incontinence
PubMed: 37308763
DOI: 10.1007/s00464-023-10090-1 -
Zentralblatt Fur Chirurgie Jun 2023One of the most common reasons to consult a coloproctologist is symptomatic haemorrhoids. Typical signs and symptoms as well as a specialised examination, including...
One of the most common reasons to consult a coloproctologist is symptomatic haemorrhoids. Typical signs and symptoms as well as a specialised examination, including proctoscopy, are essential for the correct diagnosis. The vast majority of patients can be treated conservatively with excellent results in terms of quality of life. Sclerotherapy provides good control of symptoms at any stage of haemorrhoidal disease. If conservative treatment fails, there are various surgical options. A tailored approach is mandatory. Besides well-known procedures such as Fergusson, Milligan-Morgan procedure or haemorrhoidopexy (Longo) there are less invasive options such as HAL-RAR, IRT, LT and RFA. Postoperative bleeding, pain and faecal incontinence are rare complications after surgery.
Topics: Humans; Quality of Life; Ligation; Hemorrhoids; Fecal Incontinence; Treatment Outcome
PubMed: 37267978
DOI: 10.1055/a-2068-4409 -
Southern Medical Journal Jun 2023In recent years, the local excision of benign rectal lesions or early-stage rectal cancers using minimally invasive surgical techniques has replaced radical...
OBJECTIVES
In recent years, the local excision of benign rectal lesions or early-stage rectal cancers using minimally invasive surgical techniques has replaced radical interventions that caused impairment in patients' quality of life. The aim of the present study was to investigate the feasibility of transanal minimally invasive surgery (TAMIS), as well as its excision quality, its oncologic outcomes, and its impact on anorectal function.
METHODS
Patients who underwent TAMIS at a single colorectal unit of a tertiary university hospital from 2015 until 2020 for benign rectal lesions or early-stage malignant rectal lesions, along with unsuitable patients for radical interventions, were included in the present study.
RESULTS
Twenty-five patients underwent TAMIS for rectal lesions. Their median distance from the anal verge was 7 cm (range 4-12 cm) and their median size was 3.8 cm (range 2-6 cm). The median operative duration was 75 minutes (range 30-150 minutes) and the median hospitalization interval was 2 days (range 1-6 days). In addition, the negative resection rate was 100% and the recurrence rate was 4% during an average follow-up period of 30 months (range 3-36 months). Two patients (8%) presented short-term complications, and in 1 patient (4%) a hybrid technique was required. Seventeen patients (68%) reported moderate incontinence symptoms 6 weeks postoperatively that subsided in all patients 3 months postoperatively.
CONCLUSIONS
TAMIS seemed to be a feasible technique with adequate oncologic outcomes and high excision quality, which preserved patients' quality of life. The impact of TAMIS on anorectal function after neoadjuvant chemoradiotherapy for rectal cancer should be further investigated, however.
Topics: Humans; Patient Selection; Quality of Life; Treatment Outcome; Rectal Neoplasms; Transanal Endoscopic Surgery; Anal Canal
PubMed: 37263612
DOI: 10.14423/SMJ.0000000000001570 -
Surgical Endoscopy Jul 2023Endoscopic techniques allow resections of deep submucosal invasion rectal carcinoma, but mostly are facing issues such as costs, follow-up care or size limit. Our aim...
BACKGROUND
Endoscopic techniques allow resections of deep submucosal invasion rectal carcinoma, but mostly are facing issues such as costs, follow-up care or size limit. Our aim was to design a new endoscopic technique, which retains the advantages over surgical resections while eliminating the disadvantages mentioned above.
PATIENTS AND METHODS
We propose a technique for the resection of the superficial rectal tumours, with highly suspicious deep submucosal invasion. It combines steps of endoscopic submucosal dissection, muscular resection and edge-to-edge suture of the muscular layers, finally performing the equivalent of a "transanal endoscopic microsurgery" with a flexible colonoscope (F-TEM).
RESULTS
A 60-year-old patient was referred to our unit, following the discovery of a 15 mm distal rectum adenocarcinoma. The computed tomography and the endoscopic ultrasound examination revealed a T1 tumour, without secondary lesions. Considering that the initial endoscopic evaluation highlighted a depressed central part of the lesion, with several avascular zones, an F-TEM was performed, without severe complication. The histopathological examination revealed negative resection margins, without risk factors for lymph node metastasis, no adjuvant therapy being proposed.
CONCLUSION
F-TEM allows endoscopic resection of highly suspicious deep submucosal invasion T1 rectal carcinoma and it proves to be a feasible alternative to surgical resection or other endoscopic treatments as endoscopic submucosal dissection or intermuscular dissection.
Topics: Humans; Middle Aged; Microsurgery; Rectal Neoplasms; Transanal Endoscopic Microsurgery; Carcinoma; Colonoscopes; Treatment Outcome; Retrospective Studies; Endoscopic Mucosal Resection
PubMed: 37231174
DOI: 10.1007/s00464-023-10141-7