ObjectiveTo evaluate the postoperative anal function of rectal cancer patients treated with transanal total mesorectal excision (taTME), and to analyze the influencing factors which resulted in low anterior resection syndrome (LARS) after taTME in this paper, so as to provide guidance for clinical practice.MethodsThe data about the patients with rectal cancer treated with taTME were collected at the Affiliated Nanchong Central Hospital of North Sichuan Medical College from December 2018 to December 2019, including the clinical data and follow-up data. Postoperative recovery condition of the patients’ anal function and the affecting factors caused the occurrence of severe LARS after taTME were analyzed. The patients’ anal function within 1, 6, and 12 months after taTME were evaluated, and the evaluation tools were LARS scale and Wexner scale. The follow-up period was up to December 30, 2020.ResultsA total of 67 patients were completed preoperative and postoperative follow-up at 1, 6, and 12 months. In terms of anal function, within 1 month after taTME was the worst period in which the anal function was the worst among all the points of time evaluated (1.49±0.33, 10.28±0.64, 6.42±0.60, and 3.73±0.61, respectively), and there was time trend during the follow-up period (F=66.101, P<0.001). In the first year after taTME, the patient’s anal function was in a state of continuous recovery, and the differences between the three points of time at 1, 6, and 12 months after taTME and preoperative anal function were statistically significant (P<0.010). The results of multivariate analysis indicated that the distance between the anastomotic stoma and the anal verge was independent risk factor affecting the postoperative anal function of the patients with taTME at 1 month and 6 months (P<0.010).ConclusionsWith time going, the postoperative anal function of the patients with taTME can be recovered to a certain extent. The distance between the anastomotic stoma and the anal verge was the independent factor affecting the postoperative function of the rectal cancer patients received taTME.
After more than 10 years of development, transanal total mesorectal excision (taTME) has played an important role in anus-preserving surgery for low rectal cancer. Existing studies have shown that taTME is not significantly different from traditional laparoscopy in the short-term and long-term efficacy of the treatment of low rectal cancer, and that taTME has potential advantages in postoperative functional recovery. With the maturity of taTME technology, transanal endoscopic approach has gradually been clinically applied to other rectal tumors, anastomotic stenosis, lateral lymph node dissection and other scenarios. Clinical practice shows that the transanal endoscopic approach can dissect pelvic tissues more accurately, greatly reduce the difficulty of surgery for complex pelvic diseases, improve the safety of surgery, and provide new ideas for clinical practice.
ObjectiveTo summarize the progress of surgical treatment of colorectal cancer in recent years from the anatomical features of the mesorectum, aiming to provide a new basis for surgical treatment of colorectal cancer. MethodThe relevant literatures about total mesorectal excision and complete mesocolic excision in colorectal cancer surgery in recent years were reviewed. ResultsTotal mesorectal excision and complete mesocolic excision significantly reduced the local recurrence rate of patients with colorectal cancer, improved the tumor-free survival rate and overall survival rate, and significantly improved the prognosis of patients, which may benefited from the surgeon’s detailed anatomy of mesenteric plane. In addition, based on current evidence, total mesorectal excision for colorectal cancer was safe and had fewer postoperative complications, which helped to promote the standardization of surgical treatment of colorectal cancer. ConclusionsTotal mesorectal excision and complete mesocolic excision can significantly improve histopathological prognosis compared with conventional surgery, but the advantages of long-term oncological prognosis need further study. In recent years, the combination of new techniques such as laparoscopy, robotic surgery and natural lumens, and mesenteric resection has provided new directions and new ways for surgical treatment of colorectal cancer.
ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
ObjectiveTo compare oncologic and short-term outcomes between the robotic and laparoscopic total mesorectal excision for rectal cancer. Methods This is a retrospective cohort study using a prospectively collected database. Patients’ records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent robotic-assisted total mesorectal excision (R-TME group) and one hundred and sixteen with the same histopathological stage of the tumor underwent an laparoscopic total mesorectal excision (L-TME group). Both operations were performed by the same surgeon. Results The time to the first passage of flatus ［(3.28±1.64) d vs. (6.01±2.77) d, P<0.001］, the time to the first postoperative oral fluid intake ［(4.46±1.62) d vs. (6.28±2.74) d, P<0.001） and the length of hospital stay ［（11.20±5.80）d vs. (14.72±6.90) d, P=0.023］ of the R-TME group was about 3 days faster than the L-TME group. The incidence of postoperative urinary retention (2.50% vs 7.76%, P=0.016) was significantly lower in the R-TME group than the L-TME group. However, the intraoperative blood loss of the R-TME group was more than the L-TME group ［(175.06±110.77) mL vs. (123.91±99.61) mL, P=0.031, ）. The operative time, number of lymph nodes harvested and distal margin were similar intergroup（P>0.05）. The total cost was higher in the R-TME than in the L-TME group ［(85 623.91±13 310.50) CNY vs. (67 356.79±17 107.68) CNY, P=0.084), however, this difference was statistically insignificant. ConclusionsCompared with the L-TME, the R-TME has the same oncologic outcomes and rapid postoperative short-term recovery. However, the long-term outcome of the R-TME remains to be further observed.
Since the concept of total mesorectal excision (TME) was proposed and carried out in 1982, the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased, thus TME has become the gold standard for middle and low rectal cancer surgery. However, the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high, which needs to be investigated and solved. Over the years, through systematic studies of anatomy, histology and physiology, we have confirmed that dissection anterior to Denonvilliers’ fascia for the anterior wall of rectum, and thus partial resection of Denonvilliers’ fascia, were the leading cause of nerve injury during TME operation. On the contrary, dissection posterior to Denonvilliers’ fascia and entire preservation of Denonvilliers’ fascia are feasible and necessary. Moreover, through anatomical study, Wei’s Line, the surgical marker line of Denonvilliers’ fascia is discovered for the first time, and thus innovative TME (iTME) navigated with Wei’s Line is proposed. The multi-center clinical study has confirmed that compared with traditional TME surgery, the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly, with comparable oncologic outcomes, suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages. This study systematically reviews the research process and operation standard of iTME, and summarizes the application status and future prospects of iTME.
ObjectiveTo evaluate the short-term clinical outcomes of transanal total mesorectal excision (TaTME) for mid-to-lower rectal cancer and provide evidence for clinical decision-making. MethodsThe relevant literature from domestic and international databases in recent years was reviewed to systematically assess the current application of TaTME in the treatment of mid-to-low rectal cancer. A comparative analysis was conducted between the TaTME and laparoscopic total mesorectal excision (LapTME), focusing on intraoperative outcomes, short-term postoperative recovery, intraoperative and postoperative complications, oncological prognosis, and the learning curve. ResultsConventional LapTME presented significant challenges in performing precise maneuvers within the pelvis and around the rectum, particularly in patients with “difficult pelvis” characteristics such as obesity, narrow pelvis, or male anatomy. In contrast, TaTME demonstrated certain advantages, including improved visualization of anatomical planes, reduced intraoperative bleeding, lower conversion rate to open surgery, faster short-term postoperative recovery, and enhanced specimen quality. ConclusionTaTME is a safe procedure with short-term outcomes, which is superior or comparable to those of laparoscopic surgery, offering a new surgical option for the treatment of mid-to-lower rectal cancer.
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
ObjectiveTo investigate current status of anal sphincter preservation in low rectal cancer.MethodThe recent literatures on the progress of anal sphincter preservation in the low rectal cancer were reviewed.ResultsIn the past, the surgical treatment of the low rectal cancer was mainly based on the Miles. With the deepening of the anatomical understanding, the improvement of surgical concepts, and the development of minimally invasive techniques, the treatment concept of the low rectal cancer had gradually entered the era of retaining anal and anal function. At present, many surgical methods including the transanal local excision, intersphincteric resection, transanal total mesorectal excision, etc. could be applied to the anal sphincter preservation of the lower rectal cancer, but the advantages and disadvantages of each surgical procedure and the scope of application were slightly different.ConclusionsAlthough there are many surgical procedures that can be applied to patients with low rectal cancer, none of them can achieve perfection in terms of retaining anal and anal function, reducing complications and recurrence rates, and improving survival. It is believed that with continuous understanding of rectal anatomy by surgeons, emergence of various neoadjuvant chemoradiation and new devices, and more anal sphincter preservation procedures and even artificial anal surgery, treatment of low rectal cancer will also be more good care for anal and maintenance function, so that patients can obtain a higher quality and a long-term survival opportunity.
ObjectiveTo analyze whether transanal total mesorectal excision (taTME) can achieve high-quality TME, explore the non-patient factors affecting the quality of taTME, improve the quality of taTME.MethodsThe clinical data of 76 patients undergoing taTME from January 2015 to September 2018 in the Department of Gastrointestinal Surgery of Nanchong Central Hospital were retrospectively analyzed. The operative time, intra-operative bleeding volume, positive rate of circumferential margin, integrity of mesorectum, positive rate of margin and complications were taken as the observation indexes of operative quality. The improvement of surgical equipment, structured training, and the accumulation of surgical cases (No. 1–25 cases was early group, No. 26–50 cases was mid-term group, No. 51–76 cases was later stage group) were compared as grouping conditions, and various factors affecting the quality of taTME were analyzed.Results① Pre- and post-the improvement of surgical equipment: compared to the pre-improvement of surgical equipment group, the distance between tumors and anal margin of patients in the post-improvement of surgical equipment was closer ［(4.9±1.3) cm vs. (5.9±2.7) cm, P=0.040］ and the postoperative hospital stay was shorter ［(10.6±3.9) d vs. (12.4±2.7) d, P=0.023］, while there were no significant difference in the amount of bleeding, the positive rate of circumferential margin, the integrity of mesorectum, the positive rate of margin and the complications in the two groups (P>0.05). ② Pre- and post-training for surgeon: compared to the pre-training group, the operative time in the post-training group was shortened ［(224.6±70.2) min vs. (275±77.0) min, P=0.020］, while there were no statistical differences in the amount of bleeding, the integrity of mesorectum, the difference of the positive rate of circumferential margin, the positive rate of distal margin, postoperative complications and postoperative hospital stay (P>0.05). ③ The cumulative grouping of cases: compared to the later stage group ［（218.8±69.5）min］, the operative time in the early group ［(275.2±82.6) min］ and the mid-term group ［(278.8±37.5) min］ were shortened with statistical difference (P=0.022, P=0.003). Moreover, compared to the early group ［(12.9±2.4) d］, the postoperative hospital stay in the mid-term group ［(10.8±4.0) d］ and the later stage group ［(10.2±3.6) d］ were shortened with statistical significance (P=0.032, P=0.007). However, there were no significant difference in the volume of bleeding, the positive rate of circumferential margin, the positive rate of incisal margin and the degree of mesangial integrity among the three groups (P>0.05).ConclusionstaTME can achieve high-quality TME. With the improvement of equipment, the participation of structured training and the accumulation of surgical cases, taTME achieved consistent quality in about 50 cases. The improvement of surgical equipment is the guarantee of the quality of taTME. Structured training is the key to improve the surgical quality of taTME.