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British Medical Journal Aug 1980
Topics: Ambulatory Care; Humans; Proctoscopy; Sigmoidoscopy
PubMed: 7427364
DOI: No ID Found -
British Medical Journal Aug 1980
Topics: Humans; Proctoscopy; Sigmoidoscopy
PubMed: 7427305
DOI: 10.1136/bmj.281.6237.435 -
Journal of Visceral Surgery Nov 2013Rectal resection with total mesorectal excision is the standard treatment for rectal cancers. Local excision represents an alternative with less post-operative mortality... (Review)
Review
Rectal resection with total mesorectal excision is the standard treatment for rectal cancers. Local excision represents an alternative with less post-operative mortality and morbidity and preservation of intestinal and bladder function. However, local excision cannot provide adequate nodal staging. Presently, endorectal ultrasound and magnetic resonance imaging are used to select the appropriate patients for local excision, those with limited T1 rectal tumors. There is general agreement that the ideal tumors for local excision are less or equal to 3 cm in diameter, superficial (usTis and/or usT1N0), infra-peritoneal, located below the middle rectal valve, and involving no more than 40% of the rectal circumference. Transanal tumor excision is suitable for distal tumors and transanal endoscopic microsurgery for mid and upper lesions. The principles of adequate resection margin, non-fragmentation, and full-thickness excision are similar to those for any cancer resection. Unfavorable pathologic criteria, as assessed on the fixed rectal specimen, include depth of tumor invasion (submucosal [T1sm3] or muscular [T2]), positive resection margins, vascular and/or lymphatic invasion, and poor differentiation. Further radical surgery is required in case of unfavorable criteria. Simple surveillance may be advised for superficial tumors (T1sm1) without any unfavorable criteria. Management of T1sm2 tumors without any unfavorable criteria should be discussed on a case-by-case basis.
Topics: Anal Canal; Humans; Natural Orifice Endoscopic Surgery; Patient Selection; Proctoscopy; Rectal Neoplasms; Treatment Outcome
PubMed: 24016715
DOI: 10.1016/j.jviscsurg.2013.08.004 -
Danish Medical Journal Jul 2015Total mesorectal excision (TME) is the standard surgical treatment for mid and low rectal cancer. The procedure is performed by open, laparoscopic or robotic approaches.... (Review)
Review
INTRODUCTION
Total mesorectal excision (TME) is the standard surgical treatment for mid and low rectal cancer. The procedure is performed by open, laparoscopic or robotic approaches. Transanal TME (TaTME) is a new procedure that potentially solves some difficulties in the pelvic part of the dissection. We aimed to evaluate the literature on TaTME.
METHODS
We performed a systematic search of the literature in the PubMed and Embase databases. Both authors assessed the studies. All publications on TaTME were included with the exception of review articles.
RESULTS
A total of 29 studies (336 patients) were included. Only low-quality evidence is available, and the literature consists of case reports and case series. Studies represent the initial experience of surgeons/centres. No precise indication for TaTME is yet specified other than the presence of mid and low rectal tumours, although the potential advantages seem to be related to a bulky mesorectum in the male pelvis. The preliminary results are encouraging and the most serious complication is urethral injury. The oncological results are acceptable, although the follow-up is short.
CONCLUSION
TaTME is a feasible approach for mid and low rectal cancers. Long-term follow-up data are awaited regarding functional results, local recurrence and survival, and to facilitate comparison with standard laparoscopic or robotic rectal resections.
Topics: Dissection; Female; Humans; Male; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 26183050
DOI: No ID Found -
Gynecologic Oncology Aug 2020Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we...
OBJECTIVES
Reducing anastomotic leak rates after rectosigmoid resection and anastomosis is a priority in patients undergoing gynecologic oncology surgery. Therefore, we investigated the implications of performing near-infrared angiography (NIR) via proctoscopy to assess anastomotic perfusion at the time of rectosigmoid resection and anastomosis.
METHODS
We identified all patients who underwent rectosigmoid resection and anastomosis for a gynecologic malignancy between January 1, 2013 and December 31, 2018. NIR proctoscopy was assessed via the PINPOINT Endoscopic Imaging System (Stryker).
RESULTS
A total of 410 patients were identified, among whom NIR was utilized in 133 (32.4%). There were no statistically significant differences in age, race, BMI, type of malignancy, surgery, histology, FIGO stage, hypertension, diabetes, or preoperative chemotherapy between NIR and non-NIR groups. All cases of rectosigmoid resection underwent stapled anastomosis. The anastomotic leak rate was 2/133 (1.5%) in the NIR cohort compared with 13/277 (4.7%) in the non-NIR cohort (p = 0.16). Diverting ostomy was performed in 9/133 (6.8%) NIR and 53/277 (19.9%) non-NIR patients (p < 0.001). Postoperative abscesses occurred in 8/133 (6.0%) NIR and 44/277 (15.9%) non-NIR patients (p = 0.004). The NIR cohort had significantly fewer post-operative interventional procedures (12/133, 9.0% NIR vs. 55/277, 19.9% non-NIR, p = 0.006) and significantly fewer 30-day readmissions (14/133, 10.5% NIR vs. 61/277, 22% non-NIR, p = 0.004).
CONCLUSIONS
NIR proctoscopy is a safe tool for assessing anastomotic rectal perfusion after rectosigmoid resection and anastomosis, with a low anastomotic leak rate of 1.5%. Its potential usefulness should be evaluated in randomized trials in patients undergoing gynecologic cancer surgery.
Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Anastomotic Leak; Cohort Studies; Colon, Sigmoid; Cytoreduction Surgical Procedures; Female; Fluorescein Angiography; Genital Neoplasms, Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Proctoscopy; Rectum; Retrospective Studies; Young Adult
PubMed: 32460995
DOI: 10.1016/j.ygyno.2020.05.022 -
Acta Gastro-enterologica Belgica 2019The field of rectal cancer treatment is a dynamic and changing field, due to better understanding of the pathology and new medical treatment options, but perhaps mostly... (Review)
Review
The field of rectal cancer treatment is a dynamic and changing field, due to better understanding of the pathology and new medical treatment options, but perhaps mostly due to innovations in the surgical approach. Surgery is the cornerstone for rectal cancer treatment. Currently, Total Mesorectal Excision is the gold standard. After evolution towards laparoscopic TME, improving technology has led to the development of platforms that allow transanal TME and robotic TME. In addition, local excision can be performed safer and more accurately by means of Transanal Endoscopic Microsurgery (TEM), TransAnal Minimally Invasive Surgery or Endoscopic Submucosal Dissection (ESD), possibly avoiding TME. The aim of this review is to summarize the different surgical techniques and approaches for rectal cancer in function of tumor stage and describe the specifics of the technique.
Topics: Endoscopic Mucosal Resection; Humans; Laparoscopy; Rectal Neoplasms; Rectum; Transanal Endoscopic Microsurgery; Transanal Endoscopic Surgery
PubMed: 30888757
DOI: No ID Found -
World Journal of Gastroenterology Nov 2015To describe the role of Transanal total mesorectal excision (TaTME) in minimally invasive rectal cancer surgery, to examine the differences in patient selection and in... (Review)
Review
AIM
To describe the role of Transanal total mesorectal excision (TaTME) in minimally invasive rectal cancer surgery, to examine the differences in patient selection and in reported surgical techniques and their impacts on postoperative outcomes and to discuss the future of TaTME.
METHODS
MEDLINE (PubMed), EMBASE, and The Cochrane Library were systematically searched through the 1(st) of March 2015 using a predefined search strategy.
RESULTS
A total of 20 studies with 323 patients were included. Most studies were single-arm prospective studies with fewer than 100 patients. Multiple transanal access platforms were used, and the laparoscopic approach was either multi- or single port. The procedure was initiated transanally or transabdominally. If a simultaneous approach with 2 operating surgeons was chosen, the operative time was significantly reduced.
CONCLUSION
TaTME was also associated with better TME specimens and a longer distal resection margin. TaTME is thus feasible in expert hands, but the learning curve and safety profile are not well defined. Long-term follow-up regarding anal function and oncological outcomes should be performed in the future.
Topics: Adult; Aged; Aged, 80 and over; Clinical Competence; Female; Humans; Laparoscopy; Learning Curve; Male; Middle Aged; Postoperative Complications; Rectum; Risk Factors; Transanal Endoscopic Surgery; Treatment Outcome
PubMed: 26640346
DOI: 10.3748/wjg.v21.i44.12686 -
Clinics in Colon and Rectal Surgery Feb 2017Obstructed defecation is a complex disorder that results in impaired propagation of stool from the rectum. It is one of the major subtypes of functional constipation and... (Review)
Review
Obstructed defecation is a complex disorder that results in impaired propagation of stool from the rectum. It is one of the major subtypes of functional constipation and can be secondary to either functional or anatomic etiologies. Patients with obstructed defecation typically present with symptoms of abdominal discomfort, a sensation of incomplete evacuation and rectal obstruction, passage of hard stools, the need for rectal or vaginal digitation, excessive straining, and reduced stool frequency. Evaluation of obstructed defecation is multimodal, starting with a thorough history and physical examination with focus on the abdominal, perineal, and rectal examination. Additional modalities to elicit the diagnosis of obstructed defecation include proctoscopy, colonic transit time studies, anorectal manometry, a rectal balloon expulsion test, defecography, electromyography, and ultrasound. The results from these studies should be taken in the context of each patient's clinical situation, as there is no single criterion standard for the diagnosis of obstructed defecation. Surgery is typically a last resort for these patients and the majority of patients will have good symptomatic management with diet and lifestyle changes. Patients who are found to have functional mechanisms behind their obstructed defecation also benefit from pelvic floor exercises and biofeedback therapy.
PubMed: 28144212
DOI: 10.1055/s-0036-1593427 -
International Journal of Colorectal... May 2021There is concern regarding bioaerosols from patients having procedures impacting surgical team safety. As pathogens and pollutants have been found in surgical smoke, we...
BACKGROUND
There is concern regarding bioaerosols from patients having procedures impacting surgical team safety. As pathogens and pollutants have been found in surgical smoke, we examined the potential for aerosol escape during transanal minimally invasive surgery (TAMIS) which may be particularly important given the presence of faecal contamination in the operative workspace and the specifics of its access platforms.
METHODS
Both qualitative (thermographic imaging) and quantificative (particle counting) methods were used to assess for aerosol release during TAMIS in comparison to laparoscopic operations of similar duration and equipment both at times of surgical dissection and without. TAMIS was performed using a Gelport Path Device (Applied Medical) and Airseal insufflation with valveless trocar (ConMed).
RESULTS
Significant carbon dioxide (CO) escapes during TAMIS carrying with it considerable numbers of particles. In general, particle counts were low prior to tissue dissection phases of the operation but increased substantially (25 × 10/m or over 40× background counts) during hook cautery dissection. The majority of particles were in the 0.3-0.5 micron range (where counts were increased relative to background between 42× and 65) with the highest relative increase versus background in the 0.5-1.0 micron range. Particle counts < 5 were substantially greater during the TAMIS procedure versus laparoscopic procedures (a laparoscopic-assisted parastomal hernia repair and laparoscopic cholecystectomy) employing similar tools.
CONCLUSIONS
Considerable amounts of particle-rich aerosols escape during TAMIS procedures. Although pathogens are not proven to definitely spread to healthcare staff by such material nebulisation, N95/FFP2 masks, at a minimum, seem prudent while other methods evolve to eliminate this risk.
Topics: Anal Canal; Humans; Laparoscopy; Minimally Invasive Surgical Procedures; Rectal Neoplasms; Transanal Endoscopic Surgery
PubMed: 33184703
DOI: 10.1007/s00384-020-03796-4 -
Surgical Endoscopy Dec 2023Transanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report...
BACKGROUND
Transanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report long-term oncologic and functional results. We report early results from a North American prospective multicenter phase II trial of taTME (NCT03144765).
METHODS
100 patients with stage I-III rectal adenocarcinoma located ≤ 10 cm from the anal verge (AV) were enrolled across 11 centers. Primary and secondary endpoints were TME quality, pathologic outcomes, 30-day and 90-day outcomes, and stoma closure rate. Univariable regression analysis was performed to assess risk factors for incomplete TME and anastomotic complications.
RESULTS
Between September 2017 and April 2022, 70 males and 30 females with median age of 58 (IQR 49-62) years and BMI 27.8 (IQR 23.9-31.8) kg/m underwent 2-team taTME for tumors located a median 5.8 (IQR 4.5-7.0) cm from the AV. Neoadjuvant radiotherapy was completed in 69%. Intersphincteric resection was performed in 36% and all patients were diverted. Intraoperative complications occurred in 8% including 3 organ injuries, 2 abdominal and 1 transanal conversion. The 30-day and 90-day morbidity rates were 49% (Clavien-Dindo (CD) ≥ 3 in 28.6%) and 56% (CD ≥ 3 in 30.4% including 1 mortality), respectively. Anastomotic complications were reported in 18% including 10% diagnosed within 30 days. Higher anastomotic risk was noted among males (p = 0.05). At a median follow-up of 5 (IQR 3.1-7.4) months, 98% of stomas were closed. TME grade was complete or near complete in 90%, with positive margins in 2 cases (3%). Risk factors for incomplete TME were ASA ≥ 3 (p = 0.01), increased time between NRT and surgery (p = 0.03), and higher operative blood loss (p = 0.003).
CONCLUSION
When performed at expert centers, 2-team taTME in patients with low rectal tumors is safe with low conversion rates and high stoma closure rate. Mid-term results will further evaluate oncologic and functional outcomes.
Topics: Male; Female; Humans; Middle Aged; Rectum; Prospective Studies; Transanal Endoscopic Surgery; Rectal Neoplasms; Proctectomy; Laparoscopy; Postoperative Complications; Treatment Outcome
PubMed: 37700015
DOI: 10.1007/s00464-023-10266-9