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Vivas López A, Villar OG, Borda JG, Restrepo Nuñez R, Rubio E, Nevado C, Pelaez P, Labalde Martinez M, Alias D, Falcon K, Lorenzo S, Perea García J, Ferrero E. Low anterior resection with transanal transection and single-stapled anastomosis: technical aspects and initial results. Int J Colorectal Dis 2024; 39:85. [PMID: 38837095 PMCID: PMC11153272 DOI: 10.1007/s00384-024-04646-3] [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: 05/08/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Rectal cancer (RC) is a surgical challenge due to its technical complexity. The double-stapled (DS) technique, a standard for colorectal anastomosis, has been associated with notable drawbacks, including a high incidence of anastomotic leak (AL). Low anterior resection with transanal transection and single-stapled (TTSS) anastomosis has emerged to mitigate those drawbacks. METHODS Observational study in which it described the technical aspects and results of the initial group of patients with medium-low RC undergoing elective laparoscopic total mesorectal excision (TME) and TTSS. RESULTS Twenty-two patients were included in the series. Favourable postoperative outcomes with a median length of stay of 5 days and an AL incidence of 9.1%. Importantly, all patients achieved complete mesorectal excision with tumour-free margins, and no mortalities were reported. CONCLUSION TTSS emerges as a promising alternative for patients with middle and lower rectal tumours, offering potential benefits in terms of morbidity reduction and oncological integrity compared with other techniques.
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Affiliation(s)
- Alfredo Vivas López
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain
| | | | | | - Rafael Restrepo Nuñez
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain
| | - Eduardo Rubio
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Cristina Nevado
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Pablo Pelaez
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | | | - David Alias
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Kleber Falcon
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Sofia Lorenzo
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
| | - José Perea García
- Surgery Department, Vithas Arturo Soria Hospital, Madrid, Spain.
- Molecular Medicine Unit, Department of Medicine, Institute of Biomedical Research of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), Campus Miguel de Unamuno s/n, University of Salamanca-SACYL-CSIC, 37007, Salamanca, Spain.
| | - Eduardo Ferrero
- Surgery Department, 12 de Octubre University Hospital, Madrid, Spain
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2
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Mata R, Sahnan K, Pellino G, Spinelli A, Espín-Basany E. Robotic Total Mesorectal Excision With Transanal Transection and Single-Stapled Anastomosis: A Step-By-Step Video Demonstration. Dis Colon Rectum 2024; 67:e289-e290. [PMID: 38294827 DOI: 10.1097/dcr.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Rodrigo Mata
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Kapil Sahnan
- Department of Colorectal Surgery, St. Mark's Hospital and Academic Institute, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, St. Mary's Hospital, London, United Kingdom
| | - Gianluca Pellino
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital -, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
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3
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Stevanato Filho PR, Bezerra TS, Marques TMDM, Nahime RH, Takahashi RM, Nakagawa WT, Lopes A, Aguiar S. A precise approach to robotic intracorporeal rectal transection and hand-sewn purse-string anastomosis for low anterior resection. J Surg Oncol 2024; 129:939-944. [PMID: 38221657 DOI: 10.1002/jso.27583] [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: 10/08/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024]
Abstract
This study presents a new technique for robotic-assisted intracorporeal rectal transection and hand-sewn anastomosis for low anterior resection that overcomes some limitations of conventional techniques. By integrating the advantages of the robotic platform, ensuring standardized exposure during rectal transection, and emphasizing the importance of avoiding complications associated with staple crossings, this innovation has the potential to significantly improve outcomes and reduce costs for patients with lower rectal tumors.
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Affiliation(s)
| | - Tiago S Bezerra
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Tomas M D M Marques
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Rebeca H Nahime
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renata M Takahashi
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Wilson T Nakagawa
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Ademar Lopes
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Samuel Aguiar
- Colorectal Cancer Reference Center, A.C. Camargo Cancer Center, São Paulo, Brazil
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Filho PRS, Bezerra TS, Marques TMDM, Nahime RH, Takahashi RM, Nakagawa WT, Lopes A, Aguiar S. An alternative robotic approach to precise colorectal transection and single-staple anastomosis in high anterior resection: Video correspondence. J Surg Oncol 2024; 129:802-803. [PMID: 38093694 DOI: 10.1002/jso.27563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/11/2023] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Paulo R Stevanato Filho
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Tiago S Bezerra
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Tomas M D M Marques
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Rebeca H Nahime
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Renata M Takahashi
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Wilson T Nakagawa
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Ademar Lopes
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Samuel Aguiar
- Colorectal Cancer Reference Center, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
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5
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Xu F, Yang XY, Hu Q. Prediction of symptomatic anastomotic leak after rectal cancer surgery. J Surg Oncol 2024; 129:665-667. [PMID: 38054220 DOI: 10.1002/jso.27518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Feng Xu
- Department of General Surgery, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Xi Yin Yang
- Department of Traditional Chinese Medicine, Community Health Service Center of Guali Town of Xiaoshan, Hangzhou, China
| | - Qiang Hu
- Department of general surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Daprà V, Airoldi M, Bartolini M, Fazio R, Mondello G, Tronconi MC, Prete MG, D’Agostino G, Foppa C, Spinelli A, Puccini A, Santoro A. Total Neoadjuvant Treatment for Locally Advanced Rectal Cancer Patients: Where Do We Stand? Int J Mol Sci 2023; 24:12159. [PMID: 37569532 PMCID: PMC10418822 DOI: 10.3390/ijms241512159] [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: 07/03/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The therapeutic landscape in locally advanced rectal cancer (LARC) has undergone a significant paradigm shift in recent years with the rising adoption of total neoadjuvant treatment (TNT). This comprehensive approach entails administering chemotherapy and radiation therapy before surgery, followed by optional adjuvant chemotherapy. To establish and deliver the optimal tailored treatment regimen to the patient, it is crucial to foster collaboration among a multidisciplinary team comprising healthcare professionals from various specialties, including medical oncology, radiation oncology, surgical oncology, radiology, and pathology. This review aims to provide insights into the current state of TNT for LARC and new emerging strategies to identify potential directions for future research and clinical practice, such as circulating tumor-DNA, immunotherapy in mismatch-repair-deficient tumors, and nonoperative management.
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Affiliation(s)
- Valentina Daprà
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Marco Airoldi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Michela Bartolini
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Roberta Fazio
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giuseppe Mondello
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Maria Chiara Tronconi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Maria Giuseppina Prete
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giuseppe D’Agostino
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Alberto Puccini
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
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Brunner M, Weber K, Denz A, Langheinrich M, Kersting S, Weber GF, Grützmann R, Krautz C. Omega suture technique for minimally invasive rectal anastomosis - a video vignette. Colorectal Dis 2023. [PMID: 37158135 DOI: 10.1111/codi.16598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Klaus Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Axel Denz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Melanie Langheinrich
- Department of General, Visceral, Thoracic and Vascular Surgery, Greifswald University, Greifswald, Germany
| | - Stephan Kersting
- Department of General, Visceral, Thoracic and Vascular Surgery, Greifswald University, Greifswald, Germany
| | - Georg F Weber
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
| | - Christian Krautz
- Department of General and Visceral Surgery, Friedrich-Alexander-University, Erlangen, Germany
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