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      • Record: found
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      Hybrid transanal and total mesorectal excision after transanal endoscopic microsurgery for unfavourable early rectal cancer: a report of two cases

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          Abstract

          Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology.

          Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient.

          We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.

          Translated abstract

          HIBRIDINĖ TRANSANALINĖ IR TOTALINĖ MEZOREKTALINĖ EKSCIZIJA PO TRANSANALINĖS ENDOSKOPINĖS MIKROCHIRURGIJOS NUSTAČIUS ANKSTYVĄJĮ TIESIOSIOS ŽARNOS VĖŽĮ: DVIEJŲ ATVEJŲ PRISTATYMAS

          Santrauka

          Po transanalinės endoskopinės mikrochirurginės (TEM) procedūros dėl ankstyvojo tiesiosios žarnos vėžio atlikti totalinę mezorektalinę eksciziją (TME) gana sudėtinga, tačiau kartais, esant blogos prognozės tiesiosios žarnos vėžio veiksniams, tai daryti būtina.

          Pristatome du atvejus, kai prieš TME atliekama dalinė transanalinė mezorektalinė disekcija. Taip užtikrinama, kad tiesiosios žarnos segmento kraštai – distalinis ir cirkuliarus – yra radikalūs. Abiem atvejais mezorektaliniai paviršiai buvo nepažeisti, o distaliniai kraštai adekvatūs.

          Manome, kad mūsų technika yra tinkama atlikti mažas tiesiosios žarnos rezekcijas po TEM procedūrų.

          Raktažodžiai: tiesiosios žarnos vėžys, transanalinė endoskopinė mikrochirurgija, pakartotinė operacija, totalinė mezorektalinė ekscizija, laparoskopinė chirurgija

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          • Record: found
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          Transanal minimally invasive surgery: a giant leap forward.

          Sam Atallah, S Larach, Matthew L. Albert (2010)
          Our novel approach is a hybrid between transanal endoscopic microsurgery (TEM) and single-port laparoscopy that we have termed TransAnal Minimally Invasive Surgery (TAMIS). We report the clinical application of this technique and present preliminary data that show TAMIS to be an effective tool for resection of both malignant and benign lesions of the rectum. Over a 3-month period (May-July 2009) all patients with rectal lesions who were candidates for conventional transanal excision were offered the option to undergo TAMIS resection. Patients with biopsy-proven malignant lesions were required to undergo endorectal ultrasound preoperatively to determine tumor stage. To perform TAMIS, a single-incision laparoscopic surgery port (SILS Port, Covidien) is introduced into the anal canal by applying steady manual pressure. Once seated in position, endoscopic access to the rectal vault is gained and pneumorectum is established. With this access, ordinary laparoscopic instruments, including graspers, thermal energy devices, and needle drives, are used to perform the transanal excisions. Six patients, aged 43-85 years old (mean = 59.8), underwent TAMIS resection of rectal lesions. The average distance from the anal verge was 9.3 cm and the mean tumor diameter confirmed by pathology measured 2.93 cm. There were no conversions from TAMIS to conventional transanal excision. While the average operating time was 86 min, four of the six TAMIS resections (67%) were completed in less than 1 h. The mean set-up time was only 1.9 min and this may be one reason that the mean operative time was considerably less than the average operative time for TEM surgery (120-140 min). In short-term follow-up, there was no morbidity or mortality observed. TAMIS is a feasible alternative to TEM, providing its benefits at a fraction of the cost.
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            Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery.

            Christopher Macklin, Mark W. Parsons, Nigel Scott … (2002)
            To analyze the potential variability in rates of circumferential resection margin (CRM) involvement between different surgeons and time periods and to determine the suitability of using CRM status as an immediate predictor of outcome after rectal cancer surgery. After disease stage has been taken into account, survival in rectal cancer has been shown to be very variable between surgeons and institutions. One of the major factors influencing survival is local recurrence, and this in turn is strongly related to inadequate tumor excision, particularly at the CRM. In a study involving 608 patients who underwent surgery for rectal cancer in Leeds during the 12-year period 1986 to 1997, the authors examined the role of CRM status as an immediate predictor of likely outcome, paying particular attention to its relationships with different surgeons and time periods. Of 586 patients on whom full clinical follow-up was obtained, 165 (28.2%) had CRM involvement by carcinoma on pathologic examination. Up to the end of 1998, 105 (17.9%) patients had developed local recurrence. A significantly higher proportion (38.2%) of CRM-positive patients developed local recurrence than CRM-negative ones (10.0%). Kaplan-Meier survival analysis showed significant improvements in survival for CRM-negative patients over CRM-positive patients. Survival analysis in relation to two gastrointestinal surgeons and a group of other surgeons showed survival improvements that paralleled a reduction in the rates of CRM involvement for the two gastrointestinal surgeons during the period of the study. No improvement in survival or reduction in rates of CRM involvement was seen in the group of other surgeons. These results show that CRM status may be used as an immediate predictor of survival after rectal cancer surgery and serves as a useful indicator of the quality of surgery. The frequency of CRM involvement can be used both for overall surgical audit and for monitoring the value of training programs in improving rectal surgery by individual surgeons. Its use in the current MRC CR07 study is valid and the best indicator of a requirement for further local therapy.
            Article 0 comments Cited 106 times – based on 0 reviews     Review now
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              Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial.

              Quentin Denost, Jean-Philippe Adam, Anne Rullier … (2014)
              Laparoscopic sphincter preservation for low rectal cancer is challenging because of the high risk of positive circumferential resection margin. We hypothesized that perineal dissection of the distal rectum may improve quality of surgery, compared with the conventional abdominal dissection.
              Article 0 comments Cited 51 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Med Litu
                Journal ID (iso-abbrev): Acta Med Litu
                Journal ID (publisher-id): AML
                Title: Acta Medica Lituanica
                Publisher: Lithuanian Academy of Sciences Publishers
                ISSN (Print): 1392-0138
                ISSN (Electronic): 2029-4174
                Publication date (Print): 2017
                Volume: 24
                Issue: 3
                Pages: 188-192
                Affiliations
                [1] 1 Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, Vilnius, Lithuania
                [2] 2 Department of Surgery Klaipėda University Hospital, Klaipėda, Lithuania
                [3] 3 General and Abdominal Surgery and Oncology Department, National Cancer Institute, Vilnius, Lithuania
                [4] 4 General Surgery Department, Aintree University Hospital NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
                Author notes
                Audrius Dulskas, General and Abdominal Surgery and Oncology Department, National Cancer Institute, 1 Santariškių St., LT-08406 Vilnius, Lithuania. E-mail: audrius.dulskas@ 123456gmail.com
                Article
                DOI: 10.6001/actamedica.v24i3.3553
                PMC ID: 5709058
                SO-VID: 072e3947-6e23-4b3f-8cf8-0fe9ebf77dcb
                Copyright © © Lietuvos mokslų akademija, 2017
                History
                Date received : 28 June 2017
                Date accepted : 25 September 2017
                Categories
                Subject: Research Article

                Keywords: rectal cancer,transanal endoscopic microsurgery,completion surgery,total mesorectal excision,laparoscopic surgery
                Data availability:
                Keywords: rectal cancer, transanal endoscopic microsurgery, completion surgery, total mesorectal excision, laparoscopic surgery

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