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An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery. Int J Colorectal Dis 2020; 35:1681-1687. [PMID: 32447482 PMCID: PMC7415033 DOI: 10.1007/s00384-020-03641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to evaluate the feasibility and safety of a new trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS) platform to treat rectal lesions. METHODS ARAMIS was first compared with two transanal minimally invasive surgery platforms (SILS Port and GelPOINT Path) on human cadavers. Surgeons with different experience performed running sutures at different distances, at four quadrants, using the three platforms and gave a score to visibility, safety, and maneuverability. ARAMIS was then utilized on patients affected with rectal neoplasia who met the inclusion criteria. Patients and tumor characteristic and results were prospectively collected. The follow-up examinations included proctoscopy at 3, 6, and 12 months. RESULTS According to surgeons' scores, ARAMIS improves visibility and safety with respect to other platforms for distances beyond 10 cm. The procedure, which lasted an average of 59 min, was successfully carried out in 14 patients. No intraoperative or postoperative complications were reported. The mean tumor size was 3 cm; they were located a mean of 11 cm from the anal verge. Complete removal of the lesion was possible in 13/14 patients. There was one case of adenoma recurrence at follow-up. CONCLUSION Study results showed that ARAMIS, which is equipped with an adjustable rectoscope, can be considered a safe, effective platform for transanal surgery. The rectoscope protects the rectum during the procedure, a particularly important consideration when proximal rectal lesions are being treated. Further clinical studies are warranted to confirm these encouraging results.
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Halverson AL, Morris AM, Cleary RK, Chang GJ. For Patients with Early Rectal Cancer, Does Local Excision Have an Impact on Recurrence, Survival, and Quality of Life Relative to Radical Resection? Ann Surg Oncol 2019; 26:2497-2506. [PMID: 31025228 DOI: 10.1245/s10434-019-07328-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The most appropriate treatment for early-stage rectal cancers is controversial. The advantages of local excision regarding morbidity and function must be weighed against poorer oncologic efficacy. This study aimed to clarify further the role for local excision in the treatment of rectal cancer. METHODS A systematic review of Medline, SCOPUS, and Cochrane databases was conducted. Relevant studies were selected using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data addressing five key questions about outcomes of local versus radical resection of rectal cancer were analyzed. RESULTS The 16 studies identified by this study were mostly retrospective, and none were randomized. Local excision was associated with fewer complications and better functional outcome than radical resection. Of 12 studies evaluating local recurrence, 6 showed a higher local recurrence rate among patients who underwent local excision. Two additional studies showed no increase in local recurrence rate among patients who underwent local excision of T1 lesions but a significantly higher local recurrence rate among those who underwent local excision of T2 lesions. High histologic grade, angiolymphatic invasion, perineural invasion, and depth within submucosa were features associated with a higher risk of local recurrence. In 7 of 15 studies, long-term survival was reduced compared with that of patients who underwent radical resection. CONCLUSIONS Although local excision for early-stage rectal cancer is associated with increased local recurrence and decreased overall survival compared with radical resection, local excision may be appropriate for select individuals who have T1 tumors with no adverse pathologic features.
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Affiliation(s)
- Amy L Halverson
- Division of Colon and Rectal Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Arden M Morris
- Section of Colon and Rectal Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Robert K Cleary
- Division of Colon and Rectal Surgery, St Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Allaix ME, Arezzo A, Nestorović M, Galosi B, Morino M. Local excision for rectal cancer: a minimally invasive option. MINERVA CHIR 2018; 73:548-557. [PMID: 29658675 DOI: 10.23736/s0026-4733.18.07702-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transanal excision (TAE) with conventional retractors and transanal endoscopic microsurgery (TEM) are two well established minimally invasive surgical options for the treatment of selected rectal cancers. TEM is nowadays considered the standard of care for the transanal excision of rectal tumors, since it is associated with significantly better quality of excision and lower rates of recurrence than TAE. When compared with rectal resection and total mesorectal excision, TEM has lower postoperative morbidity and better functional outcomes, with similar long-term survival rates in selected early rectal cancers. More recently, transanal minimally invasive surgery (TAMIS) has been developed as an alternative to TEM. Possible benefits of TAMIS are under evaluation.
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Affiliation(s)
- Marco E Allaix
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Bianca Galosi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy -
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Lin GP, Lee KD, Wang JY, Chen JS, Chiang CJ, Yeh CY. Status for clinically complete remission rectal cancer after concomitant chemo-radiotherapy in Taiwan. Asian J Surg 2017; 41:203-209. [PMID: 28969958 DOI: 10.1016/j.asjsur.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 06/30/2017] [Accepted: 07/07/2017] [Indexed: 10/18/2022] Open
Abstract
Treatment for Rectal cancer changed after the induction of concomitant chemo-radiotherapy, CCRT. Complete remission of the tumor leads to debate of the necessity of surgical intervention. We evaluate the treatment outcome to know if operation is beneficial to these patients. Patients received long course concomitant chemo-radiotherapy for advanced rectal cancer between 2004 and 2013 in Taiwan were enrolled. Total 2780 patients diagnosed advanced rectal cancer were enrolled. In these patients, 2578 received surgical intervention and 202 were in wait and see for complete remission tumor. Higher local recurrence rate was found with wait and see group (8.9% vs. 2.7%). Also, better overall survival, disease free survival and local recurrence free survival were seen with the surgical intervention group. Surgical intervention may be benefit for some misdiagnosed completed response to CCRT.
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Affiliation(s)
- Geng-Ping Lin
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Der Lee
- Department of Hematology and Oncology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jeng-Yi Wang
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Clinical Medical Sciences, Chang-Gung University, Taoyuan, Taiwan
| | - Jinn-Shiun Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Clinical Medical Sciences, Chang-Gung University, Taoyuan, Taiwan
| | - Chun-Ju Chiang
- Graduate Institution of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Chien-Yuh Yeh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Clinical Medical Sciences, Chang-Gung University, Taoyuan, Taiwan.
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Bartel MJ, Brahmbhatt BS, Wallace MB. Management of colorectal T1 carcinoma treated by endoscopic resection from the Western perspective. Dig Endosc 2016; 28:330-41. [PMID: 26718885 DOI: 10.1111/den.12598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/21/2015] [Accepted: 12/25/2015] [Indexed: 12/13/2022]
Abstract
Detection of early colorectal cancer is expected to rise in light of national colorectal cancer screening programs. This The present review article delineates current endoscopic risk assessments, differentiating invasive from non-invasive neoplasia, for high likelihood of lymph node metastasis in early colorectal cancer, also termed high-risk early colorectal cancer, and endoscopic and surgical resection methods from a Western hemisphere perspective.
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Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM. Transanal Minimally Invasive Surgery: Review of Indications and Outcomes from 75 Consecutive Patients. J Am Coll Surg 2016; 222:814-22. [PMID: 27016903 DOI: 10.1016/j.jamcollsurg.2016.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/11/2016] [Accepted: 02/02/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transanal minimally invasive surgery (TAMIS) is an advanced local excision platform that helps overcome technical limitations and morbidity associated with other resection methods. Our goal was to review the indications and outcomes of TAMIS in a large series. STUDY DESIGN A review of a prospective database identified patients who underwent TAMIS from 2010 to 2014. Demographic, perioperative, short-term outcomes, and recurrence data were analyzed. RESULTS There were 75 patients with 76 lesions analyzed. Mean age was 64.0 years (SD 11.6 years) and mean BMI was 27.4 kg/m(2) (SD 4.7 kg/m(2)). Median American Society of Anesthesiologists (ASA) score was 2 (range 1 to 4). There were 59 benign (77.3%) and 17 malignant (22.7%) lesions: 6 pT0, 6 pT1, 4 pT2, and 1 pT3. Median lesion distance from the anal verge was 10 cm (range 6 to 16 cm). Mean operative time was 76.0 minutes (SD 36.1 minutes). Three patients had intraperitoneal entry; all were closed transanally, but 2 had temporary diverting ileostomies fashioned to ensure healing. Median length of stay was 1 day (range 0 to 6). One patient had a fragmented lesion (1.3%). Five patients had positive margins: 2 in palliative pT2 resections, and 3 in pT1, pT2, and gastrointestinal stromal tumor (GIST) patients. They were managed with radical resection (pT1 and pT2 lesions) and surveillance/medical oncology (GIST). Postoperatively, 3 patients had complications (bleeding, rectal stricture, and recto-vaginal fistula), and all were managed nonoperatively. After median follow-up of 39.5 months (range 10.5 to 65.3 months), 1 pT1 patient with negative margins developed a local recurrence and underwent salvage APR. CONCLUSIONS Transanal minimally invasive surgery is a viable option for excision of benign or early stage rectal masses, with mid-term oncologic outcomes comparable to those of radical resection. Further, TAMIS minimizes the morbidity and can allow more patients to benefit from the minimally invasive approach.
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Affiliation(s)
- Deborah S Keller
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Reena N Tahilramani
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX
| | | | - Ali Mahmood
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Eric M Haas
- Colorectal Surgical Associates LLP, LTD, Houston, TX; Minimally Invasive Colon and Rectal Surgery, The University of Texas Medical School at Houston, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX.
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