Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: European Surgery 2/2020

05.02.2020 | original article

Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision

verfasst von: MD PhD EBSQ Coloproctology María Labalde Martínez, MD PhD Francisco Javier García Borda, MD PhD Juan Alcalde Escribano, MD PhD Cristina Nevado García, MD PhD Eduardo Rubio González, MD PhD Oscar García Villar, MD PhD Pablo Peláez Torres, MD PhD Felipe de la Cruz Vigo, MD PhD Eduardo Ferrero Herrero

Erschienen in: European Surgery | Ausgabe 2/2020

Einloggen, um Zugang zu erhalten
share
TEILEN

Summary

Introduction

Transanal total mesorectal excision (TaTME) is an alternative technique for rectal surgery that could facilitate the mobilization and the distal transection of the rectum. Our objective was to analyze whether the presence of factors affecting the difficulty of laparoscopic total mesorectal excision (TME) could affect surgical and oncological outcomes of TaTME for mid and low rectal cancer.

Methods

20 patients (13 male, 7 female) with a mean age of 66.5 years (range 55.5–75.7) and mid–low rectal cancer were prospectively submitted to TaTME. Every TaTME procedure was performed by two teams of experienced surgeons working simultaneously. Adverse conditions for laparoscopic TME were considered to be male gender, obesity, benign prostatic hypertrophy, low rectal cancer, pT3-T4, tumor size >5 cm, and neoadjuvant therapy. These factors were matched to surgical (morbidity, operative time, conversion rate) and pathological (quality of mesorectum, circumferential resection margin) outcomes.

Results

Male gender was associated with longer operative time (285 vs. 240 min, p = 0.031). There were no significant associations among the rest of the analyzed factors complicating laparoscopic TME and pathological and surgical outcomes of TaTME. Multivariate analysis showed that male gender was independently associated with operative time (β = 0.18 OR 1.019 CI95%:1.001–1.037; p = 0.042).

Conclusion

TaTME seems to be more difficult in males but not in obesity, benign prostatic hypertrophy, low rectal cancer, pT3-T4, tumor size >5 cm, or neoadjuvant therapy. TaTME could be considered an alternative surgery for low rectal cancer in the presence of these factors affecting laparoscopic TME.
Literatur
1.
Zurück zum Zitat North AB, South CD. Cancer Incidence in Antarctica (2008–2012). In: Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J, editors. Cancer Incidence in Five Continents. Vol. XI. Lyon: International Agency for Research on Cancer; 2017. Available from: http://​ci5.​iarc.​fr. North AB, South CD. Cancer Incidence in Antarctica (2008–2012). In: Bray F, Colombet M, Mery L, Piñeros M, Znaor A, Zanetti R, Ferlay J, editors. Cancer Incidence in Five Continents. Vol. XI. Lyon: International Agency for Research on Cancer; 2017. Available from: http://​ci5.​iarc.​fr.
2.
Zurück zum Zitat The GRELL EUROCARE‑5 Working Group. Trends in net survival from rectal cancer in six European Latin countries: results from the SUDCAN population-bases study. Eur J Cancer Prev. 2017;26:S48–S55. CrossRef The GRELL EUROCARE‑5 Working Group. Trends in net survival from rectal cancer in six European Latin countries: results from the SUDCAN population-bases study. Eur J Cancer Prev. 2017;26:S48–S55. CrossRef
3.
Zurück zum Zitat Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6. CrossRef Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6. CrossRef
4.
Zurück zum Zitat Akiyoshi T, Kuroyanagi H, Oya M, Konishi T. Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery. 2009;146(3):483–9. CrossRef Akiyoshi T, Kuroyanagi H, Oya M, Konishi T. Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery. 2009;146(3):483–9. CrossRef
5.
Zurück zum Zitat Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic assisted resection vs open resection on patological outcomes in rectal cancer: the AlacaRT randomized clinical trial. JAMA. 2015;314:1356–63. CrossRef Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic assisted resection vs open resection on patological outcomes in rectal cancer: the AlacaRT randomized clinical trial. JAMA. 2015;314:1356–63. CrossRef
6.
Zurück zum Zitat Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314:1346–55. CrossRef Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314:1346–55. CrossRef
7.
Zurück zum Zitat Jessup J, Benson A, Chen V. Colon and Rectum. In: Amin MB, Edge SB, Greene FL, et al., editors. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. pp. 251–74. CrossRef Jessup J, Benson A, Chen V. Colon and Rectum. In: Amin MB, Edge SB, Greene FL, et al., editors. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017. pp. 251–74. CrossRef
8.
Zurück zum Zitat Schmoll HJ, Van Cutsem E, Stein A, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23:2479–516. CrossRef Schmoll HJ, Van Cutsem E, Stein A, et al. ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol. 2012;23:2479–516. CrossRef
9.
Zurück zum Zitat Ogiso S, Yamaguchi T, Hata H, Fukuda M, et al. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: narrow pelvis is not a contraindication. Surg Endosc. 2011;25:1907–12. CrossRef Ogiso S, Yamaguchi T, Hata H, Fukuda M, et al. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: narrow pelvis is not a contraindication. Surg Endosc. 2011;25:1907–12. CrossRef
10.
Zurück zum Zitat Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, et al. Cooperative clinical investigators of the Dutch Colorectal Cancer G. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34. CrossRef Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH, et al. Cooperative clinical investigators of the Dutch Colorectal Cancer G. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol. 2002;20(7):1729–34. CrossRef
11.
Zurück zum Zitat Ryan R, Gibbons D, Hyland JM, Treanor D, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47(2):141–6. CrossRef Ryan R, Gibbons D, Hyland JM, Treanor D, et al. Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology. 2005;47(2):141–6. CrossRef
12.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Am Surg. 2004;240:205–13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Am Surg. 2004;240:205–13.
13.
Zurück zum Zitat Targarona E, Balague C, Pernas JC, Martínez C, et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3‑dimensional reconstruction of the pelvic anatomy. Ann Surg. 2008;247(8):642–9. CrossRef Targarona E, Balague C, Pernas JC, Martínez C, et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3‑dimensional reconstruction of the pelvic anatomy. Ann Surg. 2008;247(8):642–9. CrossRef
14.
Zurück zum Zitat Baik SH, Kim NK, Lee KY, Sohn SK, et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol. 2008;15:721–8. CrossRef Baik SH, Kim NK, Lee KY, Sohn SK, et al. Factors influencing pathologic results after total mesorectal excision for rectal cancer: analysis of consecutive 100 cases. Ann Surg Oncol. 2008;15:721–8. CrossRef
15.
Zurück zum Zitat Ferko A, Maly O, Orlhalmi J, Dolejs J. CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc. 2016;30:1164–71. CrossRef Ferko A, Maly O, Orlhalmi J, Dolejs J. CT/MRI pelvimetry as a useful tool when selecting patients with rectal cancer for transanal total mesorectal excision. Surg Endosc. 2016;30:1164–71. CrossRef
16.
Zurück zum Zitat Veenhof AAFA, Engel AF, van der Peet DL, Sietses C, et al. Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot stud. Int J Colorectal Dis. 2008;23:469–75. CrossRef Veenhof AAFA, Engel AF, van der Peet DL, Sietses C, et al. Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot stud. Int J Colorectal Dis. 2008;23:469–75. CrossRef
17.
Zurück zum Zitat Penna M, Hompes R, Arnold S, Wynn G, et al. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision. Ann Surg. 2019;269(4):700–11. CrossRef Penna M, Hompes R, Arnold S, Wynn G, et al. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision. Ann Surg. 2019;269(4):700–11. CrossRef
18.
Zurück zum Zitat Lin J, Kajohnwongsatit K, Sahakitrungruang C. Laparoscopic mesorectal excision in obesity: novel insights and technical strategies. Dis Colon Rectum. 2019;62:380–4. CrossRef Lin J, Kajohnwongsatit K, Sahakitrungruang C. Laparoscopic mesorectal excision in obesity: novel insights and technical strategies. Dis Colon Rectum. 2019;62:380–4. CrossRef
19.
Zurück zum Zitat Qiu Y, Lui Q, Chen G, Wang W, et al. Outcome of rectal cancer surgery in obese and nonobese patients: a meta-analysis. World J Surg Oncol. 2016;14:23. CrossRef Qiu Y, Lui Q, Chen G, Wang W, et al. Outcome of rectal cancer surgery in obese and nonobese patients: a meta-analysis. World J Surg Oncol. 2016;14:23. CrossRef
20.
Zurück zum Zitat Gustafsson UO, Scott MJ, Hubber M, Nygren J, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018. World J Surg. 2019;43(3):659–95. CrossRef Gustafsson UO, Scott MJ, Hubber M, Nygren J, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018. World J Surg. 2019;43(3):659–95. CrossRef
21.
Zurück zum Zitat Sachdeva U, Sylla P. Natural orifice approaches in rectal surgery: transanal endoscopic protectomy. In: Pigazzi A, editor. Techniques in minimally invasive rectal surgery. Basel, Switzerland: Springer; 2018. pp. 151–76. CrossRef Sachdeva U, Sylla P. Natural orifice approaches in rectal surgery: transanal endoscopic protectomy. In: Pigazzi A, editor. Techniques in minimally invasive rectal surgery. Basel, Switzerland: Springer; 2018. pp. 151–76. CrossRef
22.
Zurück zum Zitat Westwood DA, Cuda TJ, Hamilton AER, et al. Transanal total mesorectal excision for rectal cancer: state of the art. Tech Coloproctol. 2018;22:649–55. CrossRef Westwood DA, Cuda TJ, Hamilton AER, et al. Transanal total mesorectal excision for rectal cancer: state of the art. Tech Coloproctol. 2018;22:649–55. CrossRef
23.
Zurück zum Zitat Baker EJ, Waters PS, Peacock O, McCormick JJ. Advanced application of TaTME platform for a T4 anterior rectal tumor. Surg Laparosc Endosc Percutaneous Tech. 2019;29(4):e45–e49. CrossRef Baker EJ, Waters PS, Peacock O, McCormick JJ. Advanced application of TaTME platform for a T4 anterior rectal tumor. Surg Laparosc Endosc Percutaneous Tech. 2019;29(4):e45–e49. CrossRef
24.
Zurück zum Zitat Penna M, Hompes R, Arnold S, Wynn G, et al. Transanal total mesorectal excision. International registry results of the first 720 cases. Ann Surg. 2017;266(1):112–7. CrossRef Penna M, Hompes R, Arnold S, Wynn G, et al. Transanal total mesorectal excision. International registry results of the first 720 cases. Ann Surg. 2017;266(1):112–7. CrossRef
25.
Zurück zum Zitat Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Outcomes of a single surgeon-based transanal-total mesorectal excision for rectal cancer. J Gastrointest Cancer. 2018;49(4):455–62. CrossRef Caycedo-Marulanda A, Jiang HY, Kohtakangas EL. Outcomes of a single surgeon-based transanal-total mesorectal excision for rectal cancer. J Gastrointest Cancer. 2018;49(4):455–62. CrossRef
26.
Zurück zum Zitat Borja de Lacy FB, van Laarhoven J, Pena R, Arroyace MC, et al. Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc. 2018;32:2442–7. CrossRef Borja de Lacy FB, van Laarhoven J, Pena R, Arroyace MC, et al. Transanal total mesorectal excision: pathological results of 186 patients with mid and low rectal cancer. Surg Endosc. 2018;32:2442–7. CrossRef
27.
Zurück zum Zitat Roodbeen SX, Penna M, Arnold S, Wynn G. A nationwidw study on the adption and short-term outcomes of transanal total mesorectal excision in the UK. Minerva Chir. 2019;74(4):279–88. CrossRef Roodbeen SX, Penna M, Arnold S, Wynn G. A nationwidw study on the adption and short-term outcomes of transanal total mesorectal excision in the UK. Minerva Chir. 2019;74(4):279–88. CrossRef
28.
Zurück zum Zitat Muratore A, Mellano A, Marsanic P, de Simone M. Transanal Total Mesorectal Excision (TaTME) for cancer located in the lower rectum: short and mid-term results. European Journal of Surgical Oncology. 2015;41:478–83. CrossRef Muratore A, Mellano A, Marsanic P, de Simone M. Transanal Total Mesorectal Excision (TaTME) for cancer located in the lower rectum: short and mid-term results. European Journal of Surgical Oncology. 2015;41:478–83. CrossRef
29.
Zurück zum Zitat Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C. Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc. 2016;30:464–70. CrossRef Veltcamp Helbach M, Deijen CL, Velthuis S, Bonjer HJ, Tuynman JB, Sietses C. Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases. Surg Endosc. 2016;30:464–70. CrossRef
Metadaten
Titel
Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision
verfasst von
MD PhD EBSQ Coloproctology María Labalde Martínez
MD PhD Francisco Javier García Borda
MD PhD Juan Alcalde Escribano
MD PhD Cristina Nevado García
MD PhD Eduardo Rubio González
MD PhD Oscar García Villar
MD PhD Pablo Peláez Torres
MD PhD Felipe de la Cruz Vigo
MD PhD Eduardo Ferrero Herrero
Publikationsdatum
05.02.2020
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 2/2020
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-00626-y