Feasibility of transanal endoscopic total mesorectal excision for rectal cancer = results of a pilot study

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer.
Methods: This study enrolled 12 patients with clinically node negative rectal cancer located 4–12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027).
Results: The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/㎡. Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1.
Conclusion: This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications.

목차 (Table of Contents)

• INTRODUCTION
• METHODS
• RESULTS
• DISCUSSION
• REFERENCES

참고문헌 (Reference)

1 Velthuis S., "Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma" 28 : 3494-3499, 2014

2 Fernandez-Hevia M., "Transanal total mesorectal excision in rectal cancer : short-term outcomes in com parison with laparoscopic surgery" 261 : 221-227, 2015

3 Telem DA., "Transanal recto sigmoid resection via natural orifice translu menal endoscopic surgery(NOTES)with total mesorectal excision in a large human cadaver series" 27 : 74-80, 2013

4 de Lacy AM., "Transanal natural orifice transluminal endoscopic surgery(NOTES)rectal resection : "down-to-up"total mesorectal excision(TME) : short-term outcomes in the first 20 cases" 27 : 316572-, 2013

5 Atallah S., "Transanal minimally invasive surgery for total mesorectal excision(TAMISTME) : results and experience with the first 20 patients undergoing curativeintent rectal cancer surgery at a single institution" 18 : 47380-, 2014

6 Knol JJ., "Transanal endoscopic total mesorectal excision : technical aspects of approaching the mesorectal plane from below : a preliminary report" 19 : 221-229, 2015

7 Rouanet P., "Transanal endoscopic proctectomy : an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis" 56 : 408-415, 2013

8 Emhoff IA., "Transanal colo rec tal resection using natural orifice translumenal endoscopic surgery (NOTES)" 26 (26): 2942-, 2014

9 Park YM., "The effec tiveness and safety of endoscopic sub mucosal dissection compared with endo scopic mucosal resection for early gastric cancer : a systematic review and meta analysis" 25 : 266677-, 2011

10 Glynne-Jones R., "The clinical significance of the circumferen tial resection margin following pre operative pelvic chemo-radiotherapy in rectal cancer : why we need a common lan guage" 8 : 800-807, 2006

11 Sylla P., "Survival study of natural orifice translumenal endo scopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assis tance in a swine model" 24 : 2022-2030, 2010

12 Marks J., "Sphincter-sparing surgery for adenocar cinoma of the distal 3 cm of the true rec tum : results after neoadjuvant therapy and minimally invasive radical surgery or local excision" 27 : 446977-, 2013

13 Leroy J., "Single port sigmoidectomy in an experimental model with survival" 15 : 260-265, 2008

14 Guillou PJ., "Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer(MRC CLASICC trial) : multicentre, randomised controlled trial" 365 : 1718-1726, 2005

15 Jeong SY., "Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy(COREAN trial) : survival outcomes of an open-label, non-inferiority, randomised controlled trial" 15 : 76774-, 2014

16 Sylla P., "NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance" 24 : 1205-1210, 2010

17 Quirke P., "Local recurrence of rectal adeno carcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision" 2 : 996-999, 1986

18 van der Pas MH., "Laparoscopic versus open surgery for rectal cancer(COLOR II) : short-term outcomes of a randomised, phase 3 trial" 14 : 210-218, 2013

19 Whiteford MH., "Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery(NOTES)using transanal endoscopic microsurgery" 21 : 1870-1874, 2007

20 Jorge JM., "Etiology and manage ment of fecal incontinence" 36 : 77-97, 1993

21 Martling AL., "Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project" 356 : 93-96, 2000

22 Sohn DK., "Comparative study of NOTES rectosigmoidectomy in a swine model: E-NOTES vs. P-NOTES" 43 : 526-532, 2011

23 Nagtegaal ID., "Circum ferential margin involvement is still an important predictor of local recurrence in rectal carcinoma : not one millimeter but two millimeters is the limit" 26 : 350-357, 2002

24 Tuech JJ., "A step toward NOTES total meso rectal exci sion for rectal cancer : endo scopic transanal proctectomy" 261 : 228-233, 2015