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Maeda K, Koide Y, Katsuno H, Tajima Y, Hanai T, Masumori K, Matsuoka H, Shiota M. Long-term results of minimally invasive transanal surgery for rectal tumors in 249 consecutive patients. Surg Today 2023; 53:306-315. [PMID: 35962290 PMCID: PMC9950212 DOI: 10.1007/s00595-022-02570-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To delineate the long-term results of minimally invasive transanal surgery (MITAS) for selected rectal tumors. METHODS We analyzed data, retrospectively, on consecutive patients who underwent MITAS between 1995 and 2015, to establish the feasibility, excision quality, and perioperative and oncological outcomes of this procedure. RESULTS MITAS was performed on 243 patients. The final histology included 142 cancers, 47 adenomas, and 52 neuroendocrine tumors (NET G1). A positive margin of 1.6% and 100% en bloc resection were achieved. The mean operative time was 27.4 min. Postoperative morbidity occurred in 7% of patients, with 0% mortality. The median follow-up was 100 months (up to ≥ 5 years or until death in 91.8% of patients). Recurrence developed in 2.9% of the patients. The 10-year overall survival rate was 100% for patients with NET G1 and 80.3% for those with cancer. The 5-year DFS was 100% for patients with Tis cancer, 90.6% for those with T1 cancer, and 87.5% for those with T2 or deeper cancers. MITAS for rectal tumors ≥ 3 cm resulted in perioperative and oncologic outcomes equivalent to those for tumors < 3 cm. CONCLUSION MITAS is feasible for the local excision (LE) of selected rectal tumors, including tumors ≥ 3 cm. It reduces operative time and secures excision quality and long-term oncological outcomes.
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Affiliation(s)
- Kotaro Maeda
- Department of Surgery, Medical Corporation Kenikukai Shonan Keiiku Hospital, 4360 Endo, Fujisawa, Kanagawa 252-0816 Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, 444-0827 Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University Hospital, Toyoake, 470-1192 Japan
| | - Miho Shiota
- Department of Surgery, Kaisei Hospital, Sakaide, 657-0068 Japan
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Kalvach J, Ryska O, Martinek J, Hucl T, Pazin J, Hadac J, Foltan O, Kristianova H, Ptacnik J, Juhasova J, Ryska M, Juhas S. Randomized experimental study of two novel techniques for transanal repair of dehiscent low rectal anastomosis. Surg Endosc 2022; 36:4050-4056. [PMID: 34495386 DOI: 10.1007/s00464-021-08726-1] [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: 03/05/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Anastomotic leak after low anterior rectal resection is a dreadful complication. Early diagnosis, prompt management of sepsis followed by closure of anastomotic defect may increase chances of anastomotic salvage. In this randomized experimental study, we evaluated two different methods of trans-anal anastomotic repair. METHODS A model of anastomotic leak was created in 42 male pigs. Laparoscopic low anterior resection was performed with anastomosis created using a circular stapler with half of the staples removed. Two days later, animals were randomized into a TAMIS (trans-anal minimally invasive surgery) repair, endoscopic suture (ENDO) or control group with no treatment (CONTROL). Signs of intraabdominal infection (IAI), macroscopic anastomotic healing and burst tests were evaluated to assess closure quality after animals were sacrificed on the ninth postoperative day. RESULTS Closure was technically feasible in all 28 animals. Two animals had to be euthanized due to progressive sepsis at four and five days after endoscopic closure. Healed anastomosis with no visible defect was observed in 10/14 and 11/14 animals in TAMIS and ENDO groups, respectively, versus 2/14 in CONTROL (p < 0.05). Overall IAI rate was significantly lower in TAMIS (4/14; p = 0.006) and ENDO (5/14; p = 0.018) compared to CONTROL (12/14). Burst tests confirmed sealed closure in healed anastomosis with a median failure pressure of 190 (110-300) mmHg in TAMIS and 200 (100-300) mmHg in ENDO group (p = 0.644). CONCLUSION In this randomized experimental study, we found that both evaluated techniques are effective in early repair of dehiscent colorectal anastomosis with a high healing rate.
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Affiliation(s)
- J Kalvach
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic. .,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic.
| | - O Ryska
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS Foundation Trust, Lancaster, UK
| | - J Martinek
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - T Hucl
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - J Pazin
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - J Hadac
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - O Foltan
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - H Kristianova
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - J Ptacnik
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic.,1st Department of Surgery, The General University Hospital in Prague, Prague, Czech Republic
| | - J Juhasova
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
| | - M Ryska
- Surgery Department 2nd Faculty of Medicine, Charles University and Central Military Hospital, Severovýchodní II 580/22, Záběhlice, Prague, 14100, Czech Republic
| | - S Juhas
- Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czech Republic
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