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Surgical Endoscopy Apr 2022Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting.
OBJECTIVE
We aimed to summarize best evidence and develop a rapid guideline using transparent, trustworthy, and standardized methodology.
METHODS
We developed a rapid guideline in accordance with GRADE, G-I-N, and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of four general surgeons practicing colorectal surgery, a radiologist with expertise in rectal cancer, a radiation oncologist, a pathologist, and a patient representative. We conducted a systematic review and the results of evidence synthesis by means of meta-analyses were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.
RESULTS
This rapid guideline provides a weak recommendation for the use of TaTME over laparoscopic or robotic TME for low rectal cancer when expertise is available. Furthermore, it details evidence gaps to be addressed by future research and discusses policy considerations. The guideline, with recommendations, evidence summaries, and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494 .
CONCLUSIONS
This rapid guideline provides evidence-informed trustworthy recommendations on the use of TaTME for rectal cancer.
Topics: GRADE Approach; Humans; Laparoscopy; Postoperative Complications; Proctectomy; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 35212821
DOI: 10.1007/s00464-022-09090-4 -
Pharmaceutical Research Feb 2022Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have... (Comparative Study)
Comparative Study
BACKGROUND
Optimising intranasal distribution and retention of topical therapy is essential for effectively managing patients with chronic rhinosinusitis, including those that have had functional endoscopic sinus surgery (FESS). This study presents a new technique for quantifying in vitro experiments of fluticasone propionate deposition within the sinuses of a 3D-printed model from a post-FESS patient.
METHODS
Circular filter papers were placed on the sinus surfaces of the model. Deposition of fluticasone on the filter paper was quantified using high-performance liquid chromatography (HPLC) assay-based techniques. The deposition patterns of two nasal drug delivery devices, an aqueous nasal spray (Flixonase) and metered dose inhaler (Flixotide), were compared. The effects of airflow (0 L/min vs. 12 L/min) and administration angle (30° vs. and 45°) were evaluated.
RESULTS
Inhaled airflow made little difference to sinus deposition for either device. A 45° administration angle improved frontal sinus deposition with the nasal spray and both ethmoidal and sphenoidal deposition with the inhaler. The inhaler provided significantly better deposition within the ethmoid sinuses (8.5x) and within the maxillary sinuses (3.9x) compared with the nasal spray under the same conditions.
CONCLUSION
In the post-FESS model analysed, the inhaler produced better sinus deposition overall compared with the nasal spray. The techniques described can be used and adapted for in vitro performance testing of different drug formulations and intranasal devices under different experimental conditions. They can also help validate computational fluid dynamics modelling and in vivo studies.
Topics: Administration, Inhalation; Drug Compounding; Female; Fluticasone; Glucocorticoids; Humans; Metered Dose Inhalers; Middle Aged; Models, Anatomic; Nasal Sprays; Paranasal Sinuses; Printing, Three-Dimensional; Tissue Distribution; Transanal Endoscopic Surgery
PubMed: 35137359
DOI: 10.1007/s11095-021-03129-2 -
BMC Surgery Feb 2022Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the...
BACKGROUND
Transanal endoscopic microsurgery (TEM) has been accepted worldwide for the treatment of local rectal lesions. We aimed to assess the efficacy and safety of TEM in the treatment of rectal neuroendocrine tumors (RNET).
METHODS
A retrospective study of patients who had undergone TEM for RNET at our institution between December 2006 and June 2019 was performed. Demographic and tumor characteristics, operative and pathological details, complications, anal function questionnaires, and follow-up data were included.
RESULTS
A total of 144 patients was included. TEM was performed as primary excision in 54 patients, after endoscopic forceps biopsy in 57 patients, and after incomplete resection by endoscopic excision in 33 patients. The median size of all primary tumors was 0.6 cm (range, 0.3-2.0 cm), and the negative resection margin was achieved in 142 (98.6%) patients. Postoperative complications (referring to only bleeding) occurred in 3 (2.1%) patients and was successfully managed with conservative method. After a median follow-up of 75.5 months after surgery, 3 patients died of other causes, and 2 patients suffered metastasis. An anal function questionnaire was posted 24 months after TEM. Among the results, 3 (2.1%) patients complained of major low anterior resection syndrome (LARS), including 1 (0.7%) who suffered from complete incontinence, while 6 (4.2%) patients had minor LARS.
CONCLUSIONS
TEM has satisfying long-term outcomes and relatively low anal function disturbance as for the treatment of small RNET. TEM also acts as a preferred salvage treatment for incomplete endoscopic excision.
Topics: Humans; Microsurgery; Neuroendocrine Tumors; Postoperative Complications; Rectal Neoplasms; Retrospective Studies; Syndrome; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 35120483
DOI: 10.1186/s12893-022-01494-2 -
Techniques in Coloproctology Apr 2022The Flex Robotic System (Medrobotics, Raynham, MA, USA) is the first miniaturised flexible endoscopic robot that aims to allow surgical manoeuvres beyond the area...
BACKGROUND
The Flex Robotic System (Medrobotics, Raynham, MA, USA) is the first miniaturised flexible endoscopic robot that aims to allow surgical manoeuvres beyond the area currently reached by transanal endoscopic microsurgery. The aim of this study is to evaluate our initial clinical experience with this novel tool.
METHODS
We prospectively collected all consecutive cases of local excisions of rectal lesions performed with the Flex Robotic System performed at the Department of Surgical Sciences of the University of Turin between October 2018 and December 2019. Indications were benign, or early rectal lesions judged unsuitable for endoscopic removal, within 20 cm of the anal verge. Debriefing meetings after each procedure allowed technology assessment leading to the modification, development, and implementation of tools according to the clinical experience. We analysed the data in terms of the safety and efficacy of treatment.
RESULTS
Between October 2018 and February 2020, 26 patients were treated. We performed a full-thickness excision in 14 patients and a submucosal dissection in 12. The median operating time was 115 min (range 45-360 min). In six patients (23.1%), we converted to standard transanal endoscopic operation (TEO) (Karl Storz, Tuttlingen, Germany) to complete the procedure. The 30-day morbidity rate was 11.5% (3/26). Positive resection margins were detected in 4 (15.4%) patients. At a minimum follow-up of 12 months, 2 (7.7%) local recurrences were observed.
CONCLUSIONS
This first clinical series demonstrates that the Flex Robotic System is a fascinating technology that deserves further development to increase surgical dexterity, thereby overcoming current technical limitations and improving clinical outcomes.
Topics: Anal Canal; Humans; Rectal Neoplasms; Rectum; Robotics; Transanal Endoscopic Microsurgery; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 35091792
DOI: 10.1007/s10151-022-02577-1 -
Medicine Dec 2021We aimed to explore the methods to reduce or prevent nasal complications after endoscopic transsphenoidal pituitary adenoma resection. We also examined the effects of... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
We aimed to explore the methods to reduce or prevent nasal complications after endoscopic transsphenoidal pituitary adenoma resection. We also examined the effects of nasal irrigation after this procedure was performed.
METHODS
A randomized controlled trial was performed. Sixty patients of a tertiary hospital were enrolled in this study. The subjects were randomly divided into a control group and an intervention group. The subjects of the control group were given routine guidance, and 20 mL of normal saline was atomized through inhalation. The gauze was removed 7 days after surgery. The patients of the intervention group were given 50 mL of a 2% saline solution at 37°C to 38°C for bilateral nasal irrigation for 1 week. After that, patients were given 50 mL of a 0.9% normal saline solution at 37°C to 38°C for bilateral nasal irrigations. The complications of the two groups were collected at baseline, 1 week after intervention, 1 month, and 3 months after intervention. The data were analyzed using the chi-square test.
RESULTS
A 1-month after intervention, there were significant differences in dysosmia, epistaxis, and nasal adhesion between the intervention and control groups. A 3-month after intervention, only olfactory disturbances were significantly different between the two groups.
CONCLUSIONS
Nasal irrigation helps reduce the incidence of complications such as epistaxis and nasal adhesions in the early postoperative period. It can also promote the elimination or reduction of olfactory disturbances.
Topics: Adenoma; Adult; Aged; Epistaxis; Female; Humans; Male; Middle Aged; Nasal Lavage; Pituitary Neoplasms; Postoperative Complications; Saline Solution; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 34941128
DOI: 10.1097/MD.0000000000028317 -
Surgical Oncology Aug 2022At inception, transanal total mesorectal excision (TaTME) was hypothesized to be a solution for several problems encountered in pelvic surgery, particularly for distal...
At inception, transanal total mesorectal excision (TaTME) was hypothesized to be a solution for several problems encountered in pelvic surgery, particularly for distal rectal cancer. The transanal part of the procedure is less hampered by patient related factors such as visceral obesity and a narrow bony pelvis and can thus overcome access and visualization problems encountered with a pure abdominal approach. Clearly, as for any new technique, a learning curve needs to be negotiated, ideally without unacceptable harm to patients. In experienced hands, TaTME might overcome challenges found in anatomically challenging rectal cancer patients as well as for other indications. The role of TaTME is not to replace, but rather complement its abdominal counterpart.
Topics: Humans; Laparoscopy; Proctectomy; Rectal Neoplasms; Rectum; Transanal Endoscopic Surgery
PubMed: 34924223
DOI: 10.1016/j.suronc.2021.101695 -
International Journal of Colorectal... Feb 2022While local excision by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) is an option for low-risk early rectal cancers,...
PURPOSE
While local excision by transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) is an option for low-risk early rectal cancers, inaccuracies in preoperative staging may be revealed only upon histopathological evaluation of the resected specimen, demanding completion surgery (CS) by formal resection. The aim of this study was to evaluate the results of CS in a national cohort.
METHOD
This was a retrospective analysis of national registry data, identifying and comparing all Norwegian patients who, without prior radiochemotherapy, underwent local excision by TEM or TAMIS and subsequent CS, or a primary total mesorectal excision (pTME), for early rectal cancer during 2000-2017. Primary endpoints were 5-year overall and disease-free survival, 5-year local and distant recurrence, and the rate of R0 resection at completion surgery. The secondary endpoint was the rate of permanent stoma.
RESULTS
Forty-nine patients received CS, and 1098 underwent pTME. There was no difference in overall survival (OR 0.73, 95% CI 0.27-2.01), disease-free survival (OR 0.72, 95% CI 0.32-1.63), local recurrence (OR 1.08, 95% CI 0.14-8.27) or distant recurrence (OR 0.67, 95% CI 0.21-2.18). In the CS group, 53% had a permanent stoma vs. 32% in the pTME group (P = 0.002); however, the difference was not significant when adjusted for age, sex, and tumor level (OR 2.17, 0.95-5.02).
CONCLUSIONS
Oncological results were similar in the two groups. However, there may be an increased risk for a permanent stoma in the CS group.
Topics: Adenocarcinoma; Humans; Neoplasm Recurrence, Local; Rectal Neoplasms; Retrospective Studies; Transanal Endoscopic Microsurgery; Treatment Outcome
PubMed: 34914000
DOI: 10.1007/s00384-021-04083-6 -
Techniques in Coloproctology Mar 2022Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment....
BACKGROUND
Local excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms.
METHODS
All patients who underwent TAMIS from January 2016 to January 2020 at St. Olav's University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications.
RESULTS
There were 76 patients (42 men, mean age was 69 years [range 26-88 years]), The mean tumour level was 82 mm (range 20-140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8-73 mm). Three patients experienced complications needing intervention (Clavien-Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer.
CONCLUSIONS
TAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Digestive System Surgical Procedures; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Proctoscopy; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 34905132
DOI: 10.1007/s10151-021-02556-y -
Ear, Nose, & Throat Journal Jul 2024Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal...
Middle ear tumors are relatively rare, and among them, the diagnoses of middle ear lesions originating from cartilage-like tissue are even rarer. Use of transcanal endoscopic ear surgery (TEES) has increased in recent years because of its advantages, such as clear visual field and minimally invasive procedure. Here, we report a middle ear mass originating from cartilage-like tissue treated with TEES. A 62-year-old woman presented with progressive right-sided hearing loss. A white mass was revealed through the tympanic membrane, and pure-tone audiometry detected a mean 50.0 dB conductive hearing loss. Computed tomography showed a mass in the tympanic cavity. TEES was performed for diagnosis and treatment. A white translucent tumor was observed intraoperatively, and it was completely resected. Histopathological examination confirmed the diagnosis of a mass originating from degenerated cartilage-like tissue. To the best of our knowledge, this is the first study of a middle ear mass originating from cartilage-like tissue treated with TEES. TEES with its clear visual field and precise techniques was beneficial in treating the middle ear lesions circumscribed in the tympanic cavity.
Topics: Humans; Female; Middle Aged; Ear, Middle; Cartilage; Ear Neoplasms; Transanal Endoscopic Surgery; Hearing Loss, Conductive; Tomography, X-Ray Computed
PubMed: 34904447
DOI: 10.1177/01455613211065510 -
Asian Journal of Surgery Nov 2022Several studies have shown that there are no significant differences in anastomotic leakage associated with Transanal total mesorectal excision (taTME) versus...
BACKGROUND
Several studies have shown that there are no significant differences in anastomotic leakage associated with Transanal total mesorectal excision (taTME) versus laparoscopic TME (lapTME) for rectal cancer; however, little is known about late anastomotic leakage, such as that primarily found in the chronic presacral sinus. We aimed to compare the occurrence of anastomotic leakage and chronic presacral sinus in rectal cancer for taTME and lapTME.
METHODS
In this retrospective cohort study, data were collected for patients with rectal cancer who underwent surgery between January 2009 and September 2019. Of the 220 patients included in this study, 182 were in the lapTME group and 38 in the taTME group. We compared factors associated with anastomotic leakage and chronic presacral sinus formation between the two groups. A binary-logistic model was used to determine the risk factors for chronic presacral sinus.
RESULTS
Anastomotic leakage occurred in six patients (15.8%) in the taTME group and 36 patients (19.7%) in the lapTME group. Chronic presacral sinus occurred in three patients (7.9%) in the taTME group and 15 patients (8.2%) in the lapTME group. There was no significant difference in anastomotic leakage or chronic presacral sinus between groups (P = 0.569 and P = 1.000, respectively). Pathologic stage III or higher was significantly associated with chronic presacral sinus formation (P = 0.006).
CONCLUSION
There were no significant differences between taTME and lapTME regarding the incidence of anastomotic leakage or chronic presacral sinus. Almost one-third of anastomotic leakages developed into chronic presacral sinus.
Topics: Anastomotic Leak; Humans; Laparoscopy; Postoperative Complications; Rare Diseases; Rectal Neoplasms; Rectum; Retrospective Studies; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 34801358
DOI: 10.1016/j.asjsur.2021.11.009