Long-term outcomes by a transanal approach to total mesorectal excision for rectal cancer.

Autor: Marks JH; Marks Colorectal Surgical Associates, Lankenau Medical Center, Lankenau Institute for Medical Research, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA. marksj@mlhs.org., Myers EA; Marks Colorectal Surgical Associates, Lankenau Medical Center, Lankenau Institute for Medical Research, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA., Zeger EL; Section of Medical Oncology, Lankenau Medical Center, Lankenau Institute for Medical Research, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA., Denittis AS; Section of Radiation Oncology, Lankenau Medical Center, Lankenau Institute for Medical Research, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA., Gummadi M; Marks Colorectal Surgical Associates, Lankenau Medical Center, Lankenau Institute for Medical Research, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA., Marks GJ; Marks Colorectal Surgical Associates, Lankenau Medical Center, Lankenau Institute for Medical Research, Medical Science Building, Suite 375, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2017 Dec; Vol. 31 (12), pp. 5248-5257. Date of Electronic Publication: 2017 Jun 22.
DOI: 10.1007/s00464-017-5597-7
Abstrakt: Background: The challenge of performing a good total mesorectal excision (TME) dissection, particularly in the distal 1/3 of the rectum, has spurred interest in new techniques. Robotic surgery is advocated by some, and more recently, a "new" approach, the transanal total mesorectal excision, has been popularized to address this problem. While great interest in this technique exists, little long-term outcome data are available. We have been utilizing a transanal abdominal transanal approach to TME in order to facilitate the distal dissection, and here, we provide our long-term outcomes using this approach in the management of rectal cancer.
Methods: From a prospectively maintained rectal cancer database, we identified 373 consecutive rectal cancers treated with sphincter preservation surgery through a combined transanal and abdominal approach to TME. Perioperative, pathological, and oncologic outcomes were analyzed.
Results: Three hundred and seventy-three patients with rectal cancer underwent a transanally initiated TME with mean follow-up of 5.5 years. 91% of cancers were in the distal rectum. 68.9% were men and 53.2% of cancers were tethered or fixed on presentation. 97.7% received neoadjuvant radiotherapy (mean 5405 cGy, 5-fluorouracil based); average time from completion of neoadjuvant therapy to surgery was 11 weeks. 180 and 193 patients underwent completion of their operation through open and laparoscopic abdominal approaches. 96% of TME specimens were complete/near complete, 94% had a negative circumferential resection margin, and 98.6% had a negative distal margin. Perioperative morbidity and mortality rates were 13.4 and 0.3%. Overall local recurrence (LR), DM, and Kaplan-Meier 5-year actuarial survival were 7.4, 19.5, and 90%, respectively.
Conclusion: This is the first report of long-term data using a transanal approach to TME supporting this approach for rectal cancer. Our data with 5-year follow-up show that adequate distal and circumferential margins with very good-quality TME specimens, and a low risk for LR with excellent overall survival can be achieved using this technique. Our long-term results support the promising reports of early experiences in the literature.
Databáze: MEDLINE
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