1
|
Hazen SMJA, van Geffen EGM, Sluckin TC, Beets GL, Belgers HJ, Borstlap WAA, Consten ECJ, Dekker JWT, Hompes R, Tuynman JB, van Westreenen HL, de Wilt JHW, Tanis PJ, Kusters M. Long-term restoration of bowel continuity after rectal cancer resection and the influence of surgical technique: A nationwide cross-sectional study. Colorectal Dis 2024. [PMID: 38706109 DOI: 10.1111/codi.17015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/10/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024]
Abstract
AIM Literature on nationwide long-term permanent stoma rates after rectal cancer resection in the minimally invasive era is scarce. The aim of this population-based study was to provide more insight into the permanent stoma rate with interhospital variability (IHV) depending on surgical technique, with pelvic sepsis, unplanned reinterventions and readmissions as secondary outcomes. METHOD Patients who underwent open or minimally invasive resection of rectal cancer (lower border below the sigmoid take-off) in 67 Dutch centres in 2016 were included in this cross-sectional cohort study. RESULTS Among 2530 patients, 1470 underwent a restorative resection (58%), 356 a Hartmann's procedure (14%, IHV 0%-42%) and 704 an abdominoperineal resection (28%, IHV 3%-60%). Median follow-up was 51 months. The overall permanent stoma rate at last follow-up was 50% (IHV 13%-79%) and the unintentional permanent stoma rate, permanent stoma after a restorative procedure or an unplanned Hartmann's procedure, was 11% (IHV 0%-29%). A total of 2165 patients (86%) underwent a minimally invasive resection: 1760 conventional (81%), 170 transanal (8%) and 235 robot-assisted (11%). An anastomosis was created in 59%, 80% and 66%, with corresponding unintentional permanent stoma rates of 12%, 24% and 14% (p = 0.001), respectively. When corrected for age, American Society of Anesthesiologists classification, cTNM, distance to the anorectal junction and neoadjuvant (chemo)radiotherapy, the minimally invasive technique was not associated with an unintended permanent stoma (p = 0.071) after a restorative procedure. CONCLUSION A remarkable IHV in the permanent stoma rate after rectal cancer resection was found. No beneficial influence of transanal or robot-assisted laparoscopy on the unintentional permanent stoma rate was found, although this might be caused by the surgical learning curve. A reduction in IHV and improving preoperative counselling for decision-making for restorative procedures are required.
Collapse
Affiliation(s)
- Sanne-Marije J A Hazen
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Eline G M van Geffen
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Tania C Sluckin
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Geerard L Beets
- Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| | | | - Wernard A A Borstlap
- Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Esther C J Consten
- Surgery, Meander Medical Center, Amersfoort, The Netherlands
- Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Roel Hompes
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jurriaan B Tuynman
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Johannes H W de Wilt
- Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pieter J Tanis
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Miranda Kusters
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Neary E, Ibrahim T, Verschoor CP, Zhang L, Patel SV, Chadi SA, Caycedo-Marulanda A. A systematic review and meta-analysis of oncological outcomes with transanal total mesorectal excision for rectal cancer. Colorectal Dis 2024; 26:837-850. [PMID: 38590019 DOI: 10.1111/codi.16982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 01/21/2024] [Indexed: 04/10/2024]
Abstract
AIM Transanal total mesorectal (taTME) excision is a method used to assist in the radical removal of the rectum. By adopting the concept of natural orifice surgery, it offers potential benefits over conventional techniques. Early enthusiasm for this strategy led to its rapid and widespread adoption. The imposing of a local moratorium was precipitated by the discovery in Norway of an uncommon multifocal pattern of locoregional recurrence. The aim of this systematic review and meta-analysis was to determine the incidence of local recurrence after taTME for rectal cancer. METHOD Conforming to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines checklist, a systematic review and meta-analysis was conducted. This included case series and comparative studies between taTME and preferentially laparoscopic procedures published between 2010 and 2021. RESULTS There were a total of 1175 studies retrieved. After removal and screening for quality and relevance, the final analysis contained 40 studies. The local recurrence rate following taTME was 3.4% (95% CI 2.9%-3.9%, I2 = 0%) in 4987 patients with follow-up durations ranging from 0.7 to 5.5 years. Compared with laparoscopic TME, local recurrence was not statistically different for the taTME group (p = 0.076); however, it was less probable (OR = 0.51, 95% CI 0.24-1.09, I2 = 0%). Systemic recurrence and circumferential resection margin status were secondary outcomes; however, the differences were not statistically significant. CONCLUSION Our data suggest that the local recurrence for regular laparoscopic and transanal TME surgeries may be comparable, suggesting that taTME can be performed without influencing locoregional oncological outcomes in patients treated at specialized institutions and who have been cautiously selected.
Collapse
Affiliation(s)
- Emma Neary
- Queen's University, Kingston, Ontario, Canada
| | - Tarek Ibrahim
- Division of Oncology, Department of Surgery, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chris P Verschoor
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Lisa Zhang
- Queen's University, Kingston, Ontario, Canada
| | - Sunil V Patel
- Queen's University, Kingston, Ontario, Canada
- Department of Surgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Sami A Chadi
- Division of Oncology, Department of Surgery, University Health Network and Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Caycedo-Marulanda
- Queen's University, Kingston, Ontario, Canada
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
- Orlando Health Colon and Rectal Institute, Orlando, Florida, USA
| |
Collapse
|
3
|
Ammann Y, Warschkow R, Schmied B, De Lorenzi D, Reißfelder C, Bischofberger S, Marti L, Brunner W. Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A retrospective propensity score-adjusted cohort study. Int J Colorectal Dis 2024; 39:28. [PMID: 38376756 PMCID: PMC10879364 DOI: 10.1007/s00384-023-04591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE Transanal total mesorectal excision (taTME) was developed to provide better vision during resection of the mesorectum. Conflicting results have shown an increase in local recurrence and shorter survival after taTME. This study compared the outcomes of taTME and abdominal (open, laparoscopic, robotic) total mesorectal excision (abTME). METHODS Patients who underwent taTME or abTME for stages I-III rectal cancer and who received an anastomosis were included. A retrospective analysis of a prospectively conducted database was performed. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Risk factors were adjusted by propensity score matching (PSM). The secondary endpoints were local recurrence rates and combined poor pathological outcomes. RESULTS From 2012 to 2020, a total of 189 patients underwent taTME, and 119 underwent abTME; patients were followed up for a mean of 54.7 (SD 24.2) and 78.4 (SD 34.8) months, respectively (p < 0.001). The 5-year survival rates after taTME and abTME were not significantly different after PSM: OS: 78.2% vs. 88.6% (p = 0.073), CSS: 87.4% vs. 92.1% (p = 0.359), and DFS: 69.3% vs. 80.9% (p = 0.104), respectively. No difference in the local recurrence rate was observed (taTME, n = 10 (5.3%); abTME, n = 10 (8.4%); p = 0.280). Combined poor pathological outcomes were more frequent after abTME (n = 36, 34.3%) than after taTME (n = 35, 19.6%) (p = 0.006); this difference was nonsignificant according to multivariate analysis (p = 0.404). CONCLUSION taTME seems to be a good treatment option for patients with rectal cancer and is unlikely to significantly affect local recurrence or survival. However, further investigations concerning the latter are warranted. TRIAL REGISTRATION ClinicalTrials.gov (NCT0496910).
Collapse
Affiliation(s)
- Yanic Ammann
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
- Department of Surgery, Spital Grabs, Grabs, Switzerland
| | - Rene Warschkow
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| | - Bruno Schmied
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| | | | - Christoph Reißfelder
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Stephan Bischofberger
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
| | - Lukas Marti
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland.
- Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Walter Brunner
- Department of General, Visceral, Endocrine and Transplant Surgery, Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland
- Department of Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria
| |
Collapse
|
4
|
Huang CK, Shih CH, Kao YS. Elderly Rectal Cancer: An Updated Review. Curr Oncol Rep 2024; 26:181-190. [PMID: 38270849 DOI: 10.1007/s11912-024-01495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW Treatment of rectal cancer patients of advanced age should be modulated by life expectancy and tolerance. Due to the rapid advance of this field, we aim to conduct an updated review of this topic. RECENT FINDINGS The field of elderly rectal cancer has advanced a lot. This review covers all the treatment aspects of elderly rectal cancer, including the prognostic factor, surgery, radiotherapy, chemotherapy, and palliative treatment. We also provide the future aspect of the management of elderly rectal cancer. The advancement of prognostic factor research, surgery, radiotherapy, chemotherapy, and palliative treatment has made the care of elderly rectal cancer patients better. The future of these fields should focus on the definition of the elderly and the application of particle therapy.
Collapse
Affiliation(s)
- Chih-Kai Huang
- Division of General Surgery, Department of Surgery, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chi-Hsiu Shih
- Division of Hematology and Oncology, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yung-Shuo Kao
- Department of Radiation Oncology, Taoyuan General Hospital, Ministry of Health and Welfare, No.1492, Zhongshan Rd., Taoyuan Dist., Taoyuan City, 330, Taiwan.
| |
Collapse
|
5
|
Yi X, Zhang X, Li Q, Ouyang J. Comparing perioperative and oncological outcomes of transanal and laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of randomized controlled trials and prospective studies. Surg Endosc 2023; 37:9228-9243. [PMID: 37872424 DOI: 10.1007/s00464-023-10495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/23/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Meta-analysis of the results of transanal total mesorectal excision (taTME) and laparoscopic TME (laTME) regarding perioperative and oncological outcomes have been conducted. Due to the lack of high-quality randomized controlled trials (RCTs) and prospective studies in the included literature, the conclusions are unreliable. This study included RCTs and prospective studies for analysis to obtain more reliable conclusions. MATERIALS AND METHODS Systematic searches of the PubMed, Embase, and Cochrane Library databases were conducted up to June 2023. To assess the quality, the Cochrane quality assessment tool and the Newcastle-Ottawa Scale were employed. The perioperative and oncological outcomes were then analyzed. The I2 statistic was used to evaluate statistical heterogeneity and sensitivity analyses was conducted. RESULTS A total of 22 studies, comprising 5056 patients, were included in the analysis, of which 6 were RCTs and 16 were prospective studies. The conversion rate in the taTME group was significantly lower than that in the laTME group (OR 0.14, 95% CI 0.09 to 0.22, P < 0.01), and the circumferential resection margin (CRM) was longer (MD 0.99 mm, 95% CI 0.66 to 1.32 mm, P < 0.01), with a lower rate of positive CRM involvement (OR 0.68, 95% CI 0.47 to 0.97, P = 0.03). No statistically significant differences were found in terms of the operation time, intraoperative blood loss, complications, anastomotic leakage, uroschesis, obstruction, secondary operation, hospital stay, urethral injury, readmission, mortality rate within 30 days, mesorectal resection quality, number of harvested lymph nodes, distal resection margin (DRM), positive DRM, local recurrence, and distance recurrence (P > 0.05). CONCLUSION According to the findings of this meta-analysis, which is based on RCTs and prospective studies, taTME appears to have an advantage over laTME in terms of conversion rate and CRM involvement.
Collapse
Affiliation(s)
- Xianhao Yi
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China
| | - Xuan Zhang
- Department of Stomatology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China
| | - Qingchun Li
- Department of Radiology, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China
| | - Jun Ouyang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of the University of South China, Hengyang, 421001, Hunan, China.
| |
Collapse
|
6
|
Farooqi M, Hussain A, Ahmad A, Zaheer Z, Daniyal M, Tahir A, Fatima L, Maham R, Farooqui A, Khan A. Impact of trans-anal versus laparoscopic total mesorectal excision on the surgical and pathologic outcomes of patients with rectal cancer: meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2023; 408:413. [PMID: 37861749 DOI: 10.1007/s00423-023-03147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Despite its profound impact on the oncologic outcomes of rectal cancer, the most optimal surgical approach to total mesorectal excision (TME) has not been identified yet. All previous meta-analyses on this subject have been based on observational studies. This meta-analysis was conducted to assess the surgical and oncologic outcomes of laparoscopic TME (LaTME) compared to trans-anal TME (TaTME), utilizing only randomized controlled trials. DESIGN Systematic review and meta-analysis of randomized controlled trials. METHODS We searched electronic databases (MEDLINE, Cochrane CENTRAL, Clinicaltials.gov) from 2010 onwards, for all published clinical trials comparing TaTME to LaTME. Results are presented as risk ratios, with 95% CI, and pooled using the random effects model. RESULTS A total of 1691 patients, from 6 eligible randomized controlled trials, were included for analysis. Analyzed data showed no significant difference in morbidity (RR: 0.85, p = 0.15), mortality (RR: 0.50, p = 0.44), conversion to open (RR: 0.40, p = 0.07), or anastomotic leakage (RR: 0.73, p = 0.10) between TaTME and LaTME. There was also no difference in the rate of positive distal resection margin (DRM) (RR: 0.55, p = 0.10) or positive circumferential resection margin (CRM) (RR: 0.67, p = 0.30). Patients undergoing TaTME were more likely to have a complete TME (RR: 1.06, p = 0.002) and shorter hospital stays (RR: - 0.97, p < 0.00001). CONCLUSIONS Patients undergoing TaTME for rectal cancer were more likely to have a complete TME when compared to LaTME, though this did not translate into improved distal or circumferential resection margin. Additionally, TaTME and LaTME had similar surgical outcomes except for shorter length of stay with TaTME.
Collapse
Affiliation(s)
| | | | | | | | | | - Asma Tahir
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | | | | | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
7
|
Isaic A, Motofelea AC, Costachescu D, Pop GN, Totolici B, Popovici D, Diaconescu RG. What Is the Comparative Efficacy of Surgical, Endoscopic, Transanal Resection, and Radiotherapy Modalities in the Treatment of Rectal Cancer? Healthcare (Basel) 2023; 11:2347. [PMID: 37628544 PMCID: PMC10454130 DOI: 10.3390/healthcare11162347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Rectal cancer is a significant healthcare burden, and effective treatment is crucial. This research aims to compare the effectiveness of surgical and endoscopic resection, transanal resection, and radiotherapy. METHODS A literature analysis was conducted in order to identify relevant studies, by comparing the different surgical approaches and variables affecting treatment decisions. The findings were analyzed and synthesized to provide a comprehensive overview. RESULTS Surgical treatment, particularly TME (total mesorectal excision), proved consistent efficacy in achieving complete tumor resection and improving long-term survival. Endoscopic treatment and transanal resection techniques were promising for early-stage tumors but were associated with higher local recurrence rates. Radiotherapy, especially in combination with chemotherapy, played a crucial role in locally advanced cases, improving local control and reducing recurrence risk. Patient data, tumor characteristics, and healthcare system factors were identified as important factors in treatment modality selection. CONCLUSION Surgical treatment, specifically TME, remains the recommended standard approach for rectal cancer, providing excellent oncological outcomes. Endoscopic treatment and transanal resection techniques can be considered for selected early-stage cases, while radiotherapy is beneficial for locally advanced tumors. Treatment decisions should be personalized based on patient and tumor characteristics, considering the available resources and expertise within the healthcare system.
Collapse
Affiliation(s)
- Alexandru Isaic
- IInd Surgery Clinic, Timisoara Emergency County Hospital, 300723 Timisoara, Romania;
- Department X of General Surgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Cătălin Motofelea
- Department of Internal Medicine, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dan Costachescu
- Department of Orthopedics-Traumatology, Urology, Radiology, and Medical Imaging, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Gheorghe Nicusor Pop
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Bogdan Totolici
- 1st Clinic of General Surgery, Arad County Emergency Clinical Hospital, 310158 Arad, Romania;
- Department of General Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
| | - Dorel Popovici
- Department of Oncology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Razvan Gheorghe Diaconescu
- OncoHelp Hospital, 300239 Timisoara, Romania;
- Department of Surgery, Faculty of Medicine, “Victor Babes” Western University of Arad, 310025 Arad, Romania
| |
Collapse
|
8
|
Rehné Jensen L, Dohrn N, Seiersen M, Bulut O, Bech-Knudsen F, Erik Jansen J, Gögenur I, Falk Klein M. Long-term outcomes after transanal total mesorectal excision for rectal cancer in Denmark: A prospective multicenter study from the late implementation phase. Surg Oncol 2023; 49:101967. [PMID: 37356316 DOI: 10.1016/j.suronc.2023.101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE The aim of this study was to evaluate the long-term surgical and oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer during an implementation phase on a national level. METHOD This is a retrospective review of prospectively recorded data. Registration was initiated by the Danish Colorectal Cancer Group in order to assess the quality of care during the implementation of TaTME in Denmark. Data from four centers were pooled for simultaneous analysis. Short-term data was available from a prior study, and long-term data regarding recurrences, chemotherapy, and mortality was collected. RESULTS From August 2016 to April 2019, 115 TaTME procedures were registered. Patients were predominantly male (n = 85, 74%) with mid-rectal (n = 88, 77%) tumors. The overall local recurrence rate was 7.8% (n = 9) of which six patients also had systemic recurrence. Mean long-term follow-up was 59.4 months, and median time to local recurrence was 24.9 months. Local recurrences occurred predominantly among initial implementation cases. The overall mortality rate was 13% (n = 15). Of the 17 patients with recurrence, 35% (n = 6) died and developed either solely distant recurrence (n = 2, 12%) or in combination with local recurrence (n = 4, 24%). CONCLUSION We found acceptable long-term oncological results after TaTME during the implementation phase in Denmark. There was an accumulation of local recurrences in the early phase of the study which emphasizes the importance of thorough training and proctoring when starting the approach.
Collapse
Affiliation(s)
- Lasse Rehné Jensen
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark.
| | - Niclas Dohrn
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Michael Seiersen
- Department of Surgery, Zealand University Hospital Koege, Koege, Denmark
| | - Orhan Bulut
- Department of Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Flemming Bech-Knudsen
- Department of Surgery, Colorectal Cancer Centre South, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Jens Erik Jansen
- Department of Surgery, Copenhagen University Hospital North Zealand, Hillerød, Denmark
| | - Ismail Gögenur
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital Koege, Koege, Denmark; Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital Herlev, Herlev, Denmark; Danish Colorectal Cancer Group (DCCG.dk), Copenhagen, Denmark
| |
Collapse
|
9
|
Imaizumi K, Kasajima H, Ito K, Fukasawa T, Odagiri M, Yamana D, Tsuruga Y, Umehara M, Kurushima M, Munakata S, Shimoyama N, Nakanishi K. Hybrid robot-assisted abdominoperineal resection supported by simultaneous trans-perineal approach for anal gland adenocarcinoma with vaginal invasion: a case report. J Surg Case Rep 2023; 2023:rjad334. [PMID: 37309548 PMCID: PMC10257794 DOI: 10.1093/jscr/rjad334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
Hybrid surgery (abdominal robotic approach with a trans-anal approach) has been reported to improve oncological outcomes in cases involving advanced cancer or technical difficulties. A 74-year-old woman presented with anal pain and stenosis. Examination revealed palpable sclerosis on the anterior wall at the anal verge with possible vaginal invasion. A biopsy revealed an adenocarcinoma. We performed a two-team robot-assisted abdominoperineal resection combined with resection of the vagina supported by a simultaneous trans-perineal approach. After rendezvous at the posterior side, the abdominal team cut the posterior wall of the vaginal vault while the perineal team confirmed the surgical margin. Histopathological findings identified the tumour as an anal gland adenocarcinoma (pT4b [vagina] N0M0 pathological stage IIC) with a negative circumferential resection margin. Hybrid surgery combined with resection of the posterior wall of the vagina may be performed safely and is a valuable surgical option for multimodal treatment of anal adenocarcinomas.
Collapse
Affiliation(s)
- Ken Imaizumi
- Correspondence address. Department of Gastroenterological Surgery, Hakodate Municipal Hospital, 1-10-1, Minatocho, Hakodate, Hokkaido 041-8680, Japan. Tel: +81 138 43 4434; Fax: +81 138 43 4434; E-mail:
| | - Hiroyuki Kasajima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Keiichiro Ito
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Takumu Fukasawa
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Makoto Odagiri
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Daisuke Yamana
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Yosuke Tsuruga
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Minoru Umehara
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Michihiro Kurushima
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Satoru Munakata
- Department of Pathology, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Norihiko Shimoyama
- Department of Pathology, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Kazuaki Nakanishi
- Department of Gastroenterological Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| |
Collapse
|