Transanal total mesorectal excision combined with laparoscopic dissection: perioperative results and assessment of the mesorectal quality.

Autor:	Soares MB; Hospital São José do Avaí, Serviço de Proctologia, Itaperuna, RJ, Brasil., Pitombo MB; Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Departamento de Cirurgia Geral, Rio de Janeiro, RJ, Brasil., Pupo Neto JA; Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Departamento de Cirurgia, Rio de Janeiro, Rio de Janeiro, Brasil., Galvão IA; Hospital São José do Avaí, Serviço de Nutrologia, Itaperuna, RJ, Brasil.
Jazyk:	Portuguese; English
Zdroj:	Revista do Colegio Brasileiro de Cirurgioes [Rev Col Bras Cir] 2019 Nov 25; Vol. 46 (5), pp. e20192276. Date of Electronic Publication: 2019 Nov 25 (Print Publication: 2019).
DOI:	10.1590/0100-6991e-20192276
Abstrakt:	Objective: to assess the perioperative and postoperative results of transanal total mesorectal excision, as well as the quality of the specimens obtained by this technique. Methods: we conducted a prospective, descriptive study in consecutive patients with rectal adenocarcinoma located up to 10cm from the anal verge, without distant metastasis, subjected or not to neoadjuvant chemoradiotherapy. We evaluated the presence of technical difficulties, conversion to open abdominal route, surgical time and intra and postoperative complications. Through histopathological analysis, we assessed the quality of the mesorectum, involvement of the proximal and distal margins and positivity of the circumferential, classifying quality of the mesorectum as complete, partially complete or incomplete resection. Results: between December 2016 and May 2019, 41 patients underwent transanal total mesorectal excision, of which 75% were classified as clinical stage III, 13% clinical stage II and 12% clinical stage I. The average distance between the anal verge and the lower border of the tumor was 6.2cm. Forty percent of the tumors were in the anterior rectal wall and 17% were circumferential. The average operative time was 189 minutes. The average hospital stay was 4.6 days. There were no in-hospital deaths. Eighty-two percent of the specimens were classified as complete resection. Conclusion: transanal total mesorectal excision demonstrates adequate specimen quality and surgical margins, being associated with lower rates of perioperative complications, acceptable surgical time and short hospitalization.
Databáze:	MEDLINE
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