Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients - 21/07/15
, Marta M. Tasende, MD a, Salvadora Delgado, MD, PhD a, María Fernandez-Hevia, MD a, Marta Jimenez, MD, PhD a, Borja De Lacy, MD a, Antoni Castells, MD, PhD b, Raquel Bravo, MD a, Steven D. Wexner, MD, PhD, FACS c, Richard J. Heald, MD, PhD, FACS dAbstract |
Background |
The anatomic difficulties that we have to deal with in open surgery for rectal cancer have not been overcome with the laparoscopic approach. In the search for a solution, a change of concept arose: approaching the rectum from below. The main objectives of this study were to show the potential advantages of the hybrid transabdominal-transanal total mesorectal excision (taTME). This approach may improve quality of the mesorectal specimens. Second, proctectomy can be technically easier and more safely performed “down to up,” which would result in shorter surgical times, lower conversion rates, and less morbidity.
Study Design |
A prospective series of hybrid taTME was conducted from October 2011 to November 2014.
Results |
During the study period, 140 procedures were performed. Mean operative time was 166 minutes. There were no conversions or intraoperative complications. Macroscopic quality assessment of the resected specimen was complete in 97.1% and nearly complete in 2.1%. Thirty-day morbidity was minor (Clavien-Dindo I + II) in 24.2% and major (Clavien-Dindo III + IV) in 10 %. No patient died within the first 30 days postsurgery (Clavien-Dindo V). The mean follow-up was 15 months, with a 2.3% local recurrence rate and a 7.6% rate of systemic recurrence.
Conclusions |
Pathologic analysis showed a very good macroscopic quality of TME specimens, which is the most important prognostic factor in rectal cancer. Intraoperative outcomes regarding conversion, surgical times, and intraoperative complications are very satisfactory. Short-term morbidity and oncologic outcomes are as good as in other laparoscopic TME series.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : CD, CRM, TaTME, TME
Plan
| Disclosure Information: Dr Lacy is a consultant for Covidien and for Olympus Medical. Dr Wexner receives royalties for inventor's income and consulting fees from Karl Storz and Endoscopy America, stock options for prior consulting from Intuitive Surgical, and stock options for inventor's income from NovoGI. Dr Heald is a consultant for Covidien. All other authors have nothing to disclose. |
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| Disclosures outside the scope of this work: Dr Wexner is a consultant for CareFusion, Edwards LifeSciences, GI View, Incontinence Devices Inc, Johnson & Johnson Medical, Lexington Medical, LifeBond, Mederi Therapeutics, Medtronic, Novadaq, Precision Therapeutics, and Renew Medical. Dr Wexner holds patents and receives royalties from Covidien, novoGI, and Unique Surgical Innovations; he has stock in Asana Medical, LiveBond, and novoGI; and stock options for CRH Medical, EZ Surgical, and Neatstitch. |
Vol 221 - N° 2
P. 415-423 - août 2015 Retour au numéro
Article précédent
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