1
|
Binda C, Secco M, Tuccillo L, Coluccio C, Liverani E, Jung CFM, Fabbri C, Gibiino G. Early Rectal Cancer and Local Excision: A Narrative Review. J Clin Med 2024; 13:2292. [PMID: 38673565 PMCID: PMC11051053 DOI: 10.3390/jcm13082292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of the large intestine, is a fertile ground for local excision techniques performed with endoscopic or surgical techniques. Moreover, the advancement in endoscopic optical evaluation and the better definition of imaging techniques allow for a more precise local staging of early rectal cancer. Although the local treatment of early rectal cancer seems promising, in clinical practice, a significant number of patients who could benefit from local excision techniques undergo total mesorectal excision (TME) as the first approach. All relevant prospective clinical trials were identified through a computer-assisted search of the PubMed, EMBASE, and Medline databases until January 2024. This review is dedicated to endoscopic and surgical local excision in the treatment of early rectal cancer and highlights its possible role in current and future clinical practice, taking into account surgical completion techniques and chemoradiotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (C.B.); (M.S.); (L.T.); (C.C.); (E.L.); (C.F.M.J.); (G.G.)
| | | |
Collapse
|
2
|
Ogasawara RA, Okubo N, Nakanishi Y, Imasato N, Hirose K, Kataoka M, Yajima S, Ikeda K, Ito M, Masuda H. Laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for locally advanced prostate cancer with rectal infiltration. IJU Case Rep 2024; 7:83-86. [PMID: 38173461 PMCID: PMC10758906 DOI: 10.1002/iju5.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Intensive treatment is typically considered for very high-risk patients with locally advanced prostate cancer and an expected survival time of 5 years or longer. Herein, we report a case of locally advanced prostate cancer with rectal infiltration treated with laparoscopic total pelvic exenteration combined with transanal total mesorectal excision. Case presentation A 73-year-old man presented with a ring-shaped mass around the rectum. He was diagnosed with prostate cancer with rectal infiltration and underwent laparoscopic total pelvic exenteration combined with transanal total mesorectal excision following neoadjuvant androgen deprivation therapy. Twenty-two months postoperatively during ongoing androgen deprivation therapy, no biochemical recurrence was observed. Conclusion To our knowledge, this is the first report of a laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for prostate cancer with rectal infiltration. We believe this surgery may be considered a new option for high-risk prostate cancer patients with rectal infiltration.
Collapse
Affiliation(s)
| | - Naoya Okubo
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | | | - Naoki Imasato
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | - Kohei Hirose
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | - Madoka Kataoka
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | - Shugo Yajima
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| | - Koji Ikeda
- Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Hitoshi Masuda
- Department of UrologyNational Cancer Center Hospital EastKashiwaJapan
| |
Collapse
|
3
|
Choi KY, Choi S, Jeong S, Won TB. Successful Endoscopic Transsphenoidal Approach Treatment of Sphenoid Sinus Organized Hematoma Causing Visual Deficit: A Case Report. Medicina (Kaunas) 2023; 59:1802. [PMID: 37893520 PMCID: PMC10608076 DOI: 10.3390/medicina59101802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Background: Organized hematoma in the sphenoid sinus is rare, but serious complications, such as visual deficits, can occur. Three such case reports have been published previously in the literature; however, none have achieved complete recovery of the vision. Case presentation: A 69-year-old male patient was referred to the ear, nose, and throat department with an expansile soft tissue mass filling the right sphenoid sinus and blurry vision in his right eye. Complete mass removal was achieved by a wide opening of the sphenoid sinus via an endoscopic transsphenoidal approach, followed by cauterization of the feeding artery and coverage by a nasoseptal flap. The patient's vision was restored after the operation, and he declared no visual symptoms until the latest follow-up (one year after the surgery). Conclusions: Complete excision with an endoscopic endonasal transsphenoidal approach can restore visual deterioration caused by a sphenoid sinus organized hematoma.
Collapse
Affiliation(s)
- Kyu Young Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Sun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea; (K.Y.C.); (S.C.)
| | - Suji Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae-Bin Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| |
Collapse
|
4
|
Ryu S, Kitagawa T, Goto K, Nagashima A, Kobayashi T, Shimada J, Ito R, Nakabayashi Y. Transanal Total Mesorectal Excision for Extended Surgery in the Early Stage After Introduction. Anticancer Res 2023; 43:2211-2217. [PMID: 37097660 DOI: 10.21873/anticanres.16384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM The effectiveness of transanal total mesorectal excision (Ta-TME) in extended surgery (ES) has been discussed. This study examined the short-term outcomes of the first 31 patients who underwent Ta-TME after its introduction and verified the safety of Ta-TME in ES in the early stage following its introduction. PATIENTS AND METHODS Thirty-one consecutive patients who underwent Ta-TME between December 2021 and January 2023 at our institution were included. The indications for Ta-TME were rectal tumors that could be palpated during rectal examination and bulky tumors that were deemed unresectable without Ta-TME. Short-term outcomes were retrospectively compared between patients who underwent normal Ta-TME, (n=27, TME group) and patients who underwent ES beyond TME (n=4, ES group). The data are shown as the median and interquartile range. Statistical analysis was performed with the Mann-Whitney U-test and Fisher's exact test. RESULTS Total pelvic exenteration (TPE) was performed in the 4th and 8th patients; the 9th patient underwent a combined resection of the right adnexa and urinary bladder wall. The 31st patient underwent a combined resection of the uterus and the right adnexa. The operative time was 353 [285-471] vs. 569 [411-746] min for the TME and ES groups (p=0.039). Blood loss was 8 [5-40] vs. 45 [23-248] ml (p=0.065); postoperative hospital stay was 15 [10-19] vs. 11 [9-15] days (p=0.201); postoperative complications (higher than grade III) were 5 (19%) vs. 0 (p=1.000). Negative CRM was achieved in all cases. CONCLUSION Ta-TME in ES was as safe as normal Ta-TME in the early stage after its introduction.
Collapse
Affiliation(s)
- Shunjin Ryu
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Takahiro Kitagawa
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Keisuke Goto
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Atsushi Nagashima
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Takehiro Kobayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Junichi Shimada
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Ryusuke Ito
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Yukio Nakabayashi
- Department of Digestive Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| |
Collapse
|
5
|
Zammit AP, Brown I, Hooper JD, Clark DA, Riddell AD. A population-based study of the management of rectal malignant polyps and the use of trans-anal surgery. ANZ J Surg 2022; 92:2949-2955. [PMID: 35848607 PMCID: PMC9795907 DOI: 10.1111/ans.17917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Rectal malignant polyps can be managed by use of trans-anal resections (TAR). Traditional techniques of resection have been replaced by use of platforms such as trans-anal minimally invasive surgery (TAMIS) or trans-anal endoscopic microsurgery (TEM). This study reviewed the management of rectal malignant polyps, in particular focussing on when clinicians used TAR. METHODS A population wide cohort study of all malignant rectal polyps diagnosed in Queensland, Australia from 2011 to 2018 was undertaken. Patient and pathological factors were compared across the management strategies of polypectomy, TAR and rectal resection. RESULTS Overall 430 patients were diagnosed with a malignant rectal polyp during the study period, with 103 undergoing a TAR. There was increasing use of TAR across the study period as a management strategy (P < 0.001). Polypectomy alone was more likely to be the management strategy over TAR or rectal resection if there were clear margins (P < 0.001). The distance to the closest polypectomy margin was also significantly higher in the polypectomy group with mean clearance 2.09 mm in polypectomy group versus 0.86 mm in TAR group and 0.99 mm in resection group (P < 0.001). Rectal resection was more likely to be the management strategy over TAR if there was LVI (P < 0.001), depth of invasion was deeper (P < 0.001) and there was tumour budding (P = 0.001). CONCLUSION TAR is an effective management strategy for rectal polyps and is utilized particularly in rectal malignant polyps when there are close or involved margins. Future guideline development should consider incorporation of TAR given the advances in techniques afforded by TAMIS or TEM platforms.
Collapse
Affiliation(s)
- Andrew P. Zammit
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Ian Brown
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Envoi Specialist PathologistsBrisbaneQueenslandAustralia,Department of Colorectal SurgeryRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - John D. Hooper
- Mater ResearchTranslational Research InstituteBrisbaneQueenslandAustralia
| | - David A. Clark
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of Colorectal SurgeryRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia,Mater ResearchTranslational Research InstituteBrisbaneQueenslandAustralia,Faculty of Medicine and HealthUniversity of Sydney and Surgical Outcomes Research Centre (SOuRCe)SydneyNew South WalesAustralia,St Vincent's Private Hospital NorthsideBrisbaneQueenslandAustralia
| | - Andrew D. Riddell
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Department of SurgeryRedcliffe HospitalRedcliffeQueenslandAustralia
| |
Collapse
|
6
|
Abstract
Transanal endoscopic surgery (TES), which is performed through a variety of transanal endoluminal multitasking surgical platforms, was developed to facilitate endoscopic en bloc excision of rectal lesions as a minimally invasive alternative to radical proctectomy. Although the oncologic safety of TES in the treatment of malignant rectal tumors has been an area of vigorous controversy over the past two decades, TES is currently accepted as an oncologically safe approach for the treatment of carefully selected early and superficial rectal cancers. TES can also serve as both a diagnostic and potentially curative treatment of partially resected unsuspected malignant polyps. In this article, indications and contraindications for transanal endoscopic excision of early rectal cancer lesions are reviewed, as well as selection criteria for the most appropriate transanal excisional approach. Preoperative preparation and surgical technique for complications of TES will be reviewed, as well as recommended surveillance and management of upstaged tumors.
Collapse
Affiliation(s)
| | - Patricia Sylla
- Icahn School of Medicine at Mount Sinai, New York, New York,Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital, New York, New York,Address for correspondence Patricia Sylla, MD, FACS, FASCRS Division of Colon and Rectal Surgery, Department of Surgery, Mount Sinai Hospital5 East 98th Street, Box 1259, New York, NY 10029
| |
Collapse
|
7
|
Fournier FR, Brown CJ. Transanal Endoscopic Surgery: Who Should Be Doing This Procedure? Clin Colon Rectal Surg 2022; 35:99-105. [PMID: 35237104 PMCID: PMC8885151 DOI: 10.1055/s-0041-1742109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Transanal endoscopic surgery (TES) was introduced in the 1980s, but more widely adopted in the late 2000s with innovations in instrumentation and training. Moreover, the global adoption of minimally invasive approaches to abdominal procedures has led to translatable skills for TES among colorectal and general surgeons. While there are similarities to laparoscopic surgery, TES has unique challenges related to the narrow confines of intraluminal surgery, angled instrumentation, and relatively uncommon indications limiting the opportunity to practice. The following review discusses the current evidence on TES learning curves, including potential limitations related to the broad adoption of TES by general surgeons. This article aims to provide general recommendations for the safe expansion of TES.
Collapse
Affiliation(s)
- François Rouleau Fournier
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carl James Brown
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada,Address for correspondence Carl James Brown, MD, MSc, FACS, FRCSC Department of Surgery, St. Paul's Hospital, University of British Columbia1081 Burrard Street, Room C310, Third Floor, Burrard Building, Vancouver, BCCanada V6Z 1Y6
| |
Collapse
|
8
|
Abstract
Transanal endoscopic surgery encompasses the minimally invasive surgical techniques used to operate in the rectum under magnification while maintaining pneumorectum via a resectoscope or port. The view, magnification, and surgical precision afforded by these advanced transanal techniques have resulted in excellent specimen quality and low recurrence rates, especially compared with traditional transanal surgery. For rigid platforms, the surgeon operates through a rigid 4-cm diameter steel proctoscope of varying lengths that is clamped to the operating table with an articulating arm. Transanal minimally invasive surgery (TAMIS) is a newer flexible platform using a disposable port which "hooks" into the anorectal ring to remain in place. The cost-effectiveness and versatility of the TAMIS platform have resulted in its popularity and use in more advanced applications such as transanal total mesorectal excision. Ultimately, the choice of operating platform should be based on surgeon preference, patient characteristics, availability, and cost. The pros and cons of each platform will be discussed in this article.
Collapse
Affiliation(s)
- Liam A. Devane
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Meghan C. Daly
- AdventHealth, Digestive Health and Surgical Institute, Department of Colorectal Surgery, Orlando, FL
| | - Matthew R. Albert
- AdventHealth, Digestive Health and Surgical Institute, Department of Colorectal Surgery, Orlando, FL,Address for correspondence Matthew R. Albert, MD AdventHealth, Digestive Health and Surgical Institute, Department of Colorectal Surgery2501 North Orange Ave, Orlando, FL 32804
| |
Collapse
|
9
|
Abstract
Transanal surgery has gained in popularity during the latter part of the last decade for both rectal cancer and benign disease. The current role for local excision of early rectal neoplastic lesions has expanded due to better understanding of risk factors for lymph node metastasis and heightened awareness for the long-term sequelae of radical surgery. Transanal resection of the rectum (both for cancer or inflammatory bowel diseases) has now been established as a successful procedure that overcomes some of the limitations of the abdominal approaches. Once the feasibility, safety, and the oncologic results of transanal minimally invasive approaches for patients with rectal cancer have been acknowledged, quality of life and functional outcomes have become increasingly important issues. This article provides an overview of the different techniques currently available for the minimally invasive transanal treatment of rectal lesions, particularly focusing on functional outcomes.
Collapse
Affiliation(s)
- Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Francesco Maria Carrano
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy,Address for correspondence Antonino Spinelli, MD, PhD Division of Colon and Rectal Surgery, Department of Surgery, Humanitas Clinical and Research CenterIRCCS, Building 2, Via Manzoni 56, Rozzano, Milano 20089Italy
| |
Collapse
|
10
|
Amorim Filho FS, Gripp FM, Faria GS, Capuzzo Gonçalves M, Miyahira L. Hemangiopericytoma: Conducts and perioperative management of an extent sinonasal tumor in a Jehovah's Witnesses patient - Case report. Cancer Rep (Hoboken) 2022; 5:e1609. [PMID: 35194976 PMCID: PMC9458489 DOI: 10.1002/cnr2.1609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/02/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself. Case We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per‐operative care and restrictions being respected and attended. Conclusions The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.
Collapse
Affiliation(s)
- Francisco S Amorim Filho
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil.,Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Flávio M Gripp
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Guilherme S Faria
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
| | - Mateus Capuzzo Gonçalves
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital das Clínicas de Goiânia (HC-UFG), Goiânia, Brazil
| | - Lincoln Miyahira
- Head and Neck Surgery and Otorhinolaryngology Service, Instituto da Tireoide e Laringe, Goiânia, Brazil
| |
Collapse
|
11
|
Serra-Aracil X, Montes N, Mora-Lopez L, Serracant A, Pericay C, Rebasa P, Navarro-Soto S. Preoperative Diagnostic Uncertainty in T2-T3 Rectal Adenomas and T1-T2 Adenocarcinomas and a Therapeutic Dilemma: Transanal Endoscopic Surgery, or Total Mesorectal Excision? Cancers (Basel) 2021; 13:cancers13153685. [PMID: 34359589 PMCID: PMC8345169 DOI: 10.3390/cancers13153685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, or between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: transanal endoscopic surgery (TES) or total mesorectal excision (TME)? METHODS An observational study of a cohort of 803 patients who underwent TES from 2004 to 2021. Patients operated on for adenoma (group I) and low-grade T1 adenocarcinoma (group II) were included. The variables related to uncertain diagnosis, and to the definitive pathological diagnosis of adenocarcinoma stage higher than T1, were analyzed. RESULTS A total of 638 patients were included. Group I comprised 529 patients, 113 (21.4%) with uncertain diagnosis. Seventeen (15%) eventually had a pathological diagnosis of adenocarcinoma higher than T1. However, the variable diagnostic uncertainty was a risk factor for adenocarcinoma above T1 (OR 2.3, 95% CI 1.1-4.7). Group II included 109 patients, eight with uncertain diagnosis (7.3%). Two patients presented a definitive pathological diagnosis of adenocarcinoma above T1. CONCLUSIONS On the strength of these data, we recommend TES as the initial indication in cases of diagnostic uncertainty. Multicenter studies with larger samples for both groups should now be performed to further assess this strategy of initiating treatment with TES.
Collapse
Affiliation(s)
- Xavier Serra-Aracil
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
- Correspondence:
| | - Noemi Montes
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
| | - Laura Mora-Lopez
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
| | - Anna Serracant
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
| | - Carles Pericay
- Medical Oncology Department, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Pere Rebasa
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
| | - Salvador Navarro-Soto
- Servicio de Cirugía General y del Ap. Digestivo, Departament de Cirurgia, Institut d’Investigació i Innovació Parc Tauli I3PT, Parc Tauli Hospital Universitari, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain; (N.M.); (L.M.-L.); (A.S.); (P.R.); (S.N.-S.)
| |
Collapse
|
12
|
Safaeian R, Hassani V, Ghandi A, Mohseni M. Desmopressin nasal spray reduces blood loss and improves the quality of the surgical field during functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol 2021; 37:261-265. [PMID: 34349377 PMCID: PMC8289654 DOI: 10.4103/joacp.joacp_227_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/19/2019] [Accepted: 10/14/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Making a dry surgical field during functional endoscopic sinus surgery (FESS) is a challenge for anesthetists. This study was conducted to evaluate the pre-emptive hemostatic effects of a single dose of an intranasal spray of desmopressin (DDAVP) in sinus surgery. Material and Methods Sixty consecutive patient's as first-time candidates for FESS due to chronic sinusitis were enrolled. They were randomly allocated to receive either a nasal spray of DDAVP 20 μg or sterile water before induction of anesthesia. Management of anesthesia was achieved with propofol and remifentanil infusions. Blood loss, quality of the surgical field, and surgeon's satisfaction were compared between the two groups. Results Blood loss in the DDAVP group was 147 ± 43 mL and in the placebo group 212 ± 64 mL (mean ± SD, P < 0.01). The quality of the surgical field in the DDAVP group was better than the placebo group. (median score, 1 (1-2) vs. 2 (1-3), P = 0.017). Surgeons were more satisfied with the surgical field in the DDAVP group than in the control group (median score, 4 (2.8-5) vs. 3 (2-3), P = 0.04). Conclusion Premedication with nasal spray DDAVP 20 μg effectively reduces bleeding and improves the surgical field during FESS.
Collapse
Affiliation(s)
- Reza Safaeian
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Valiollah Hassani
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Arman Ghandi
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| | - Masood Mohseni
- Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Li Q, Sun J, Yin L, Ji F. Rectovaginal Fistula With Double Vagina and Anastomotic Stenosis: A Case Report Following Rectal Cancer Surgery. Front Oncol 2021; 11:549211. [PMID: 33680958 PMCID: PMC7934615 DOI: 10.3389/fonc.2021.549211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
Rectovaginal fistula (RVF) occurs as a result of abnormal epithelialized connections between the rectum and vagina. Rectal cancer surgery remains the major cause of RVF. Here, we report a rare postoperative complication in which a patient with a double uterine and vagina received RVF following rectal cancer surgery. The patient received radiotherapy and developed rectal anastomotic stenosis leading to scar hyperplasia around the fistula, making repair difficult. Complex RVF is prone to release, which despite the multitude of procedures and treatments reported, optimal strategies remain controversial. Our previous studies showed how the use of rectal mucosal advancement flap (RMAF) with transanal endoscopic surgery (TES) can repair mid-low RVF. We successfully repaired RVF and rectal anastomotic stenosis with staging TES in this complex case. This highlights the safety and utility of TES treatment for complex RVF. Further studies are now required to confirm its effectiveness.
Collapse
Affiliation(s)
- Qiwei Li
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianhua Sun
- Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Yin
- Department of Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fu Ji
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
14
|
de Lima RDAL, Parra RS, Feitosa MR, Feres O, da Rocha JJR. Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope. Acta Cir Bras 2020; 35:e202000807. [PMID: 32965304 PMCID: PMC7518222 DOI: 10.1590/s0102-865020200080000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. METHODS We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. RESULTS This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. CONCLUSIONS The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.
Collapse
Affiliation(s)
- Roberta Denise Alkmin Lopes de Lima
- Fellow PhD degree, Postgraduate Program in Surgical Clinic, Division of Coloproctology, Department of Anatomy and Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; manuscript preparation, final approval
| | - Rogério Serafim Parra
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, manuscript writing, critical revision, final approval
| | - Marley Ribeiro Feitosa
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, statistics analysis, final approval
| | - Omar Feres
- PhD, Associated Professor, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, critical revision, final approval
| | - José Joaquim Ribeiro da Rocha
- PhD, Associated Professor, Head, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; critical revision, final approval
| |
Collapse
|
15
|
Tokunaga T, Higashijima J, Yoshikawa K, Nishi M, Kashihara H, Takasu C, Shimada M. The usefulness of intraoperative X-ray fluoroscopy in avoiding urethral injury during transanal total mesorectal excision. Asian J Endosc Surg 2020; 13:242-245. [PMID: 31215751 DOI: 10.1111/ases.12717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/15/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Urethral injury is one of the most important complications that can occur during transanal total mesorectal excision in male patients with rectal cancer. This report shows the usefulness of intraoperative X-ray fluoroscopy to avoid urethral injury associated with transanal total mesorectal excision. MATERIALS AND SURGICAL TECHNIQUE Real-time navigation using fluoroscopy was performed to check the distance between the urethra and the dissection line at the level of the exposed rectourethral muscle, the middle level of the divided rectourethral muscle, and the level at which the prostate was identified. DISCUSSION The dissection was completed transanally up to the level of peritoneal reflection on the anterior side without urethral injury. Pathological examination confirmed that the circumferential resection margin was tumor free. This novel technique using intraoperative X-ray fluoroscopy is an easy-to-use approach that helps prevent urethral injury in male patient who undergo transanal total mesorectal excision for rectal cancer.
Collapse
Affiliation(s)
- Takuya Tokunaga
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Jun Higashijima
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, Tokushima, Japan
| | | | - Chie Takasu
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima, Japan
| |
Collapse
|
16
|
Abstract
Background Total mesorectal excision (tme) is the current standard of care for the treatment of rectal cancer. However, that surgery is associated with significant morbidity and mortality. Clinicians and patients are seeking alternatives to radical resection. Currently, prevalent organ-sparing strategies under investigation include local excision and nonoperative management (nom). Methods We reviewed the current evidence in the literature to create an overview of the use of transanal endoscopic surgery and watch-and-wait strategies in the modern management of rectal cancer. Results Compared with radical resection, transanal endoscopic surgery in patients with early rectal cancer (cT1) having favourable histopathologic features is associated with an increased risk of local recurrence, but no difference in 5-year survival. In patients with T2 or early T3 cancer, strategies that use neoadjuvant or adjuvant therapy as adjuncts to local excision are under evaluation. Nonoperative management is a new option for patients who experience a complete clinical response after neoadjuvant chemoradiotherapy (ncrt). The selection criteria that will appropriately identify patients for whom nom will succeed are not established. Conclusions Local excision is appropriate for early rectal cancer with favourable histopathologic features. Although organ-preserving strategies are promising, the quality of the evidence to date is insufficient to replace the current standard care in most patients. Patients should be offered nom in the safe setting of a clinical trial or registry. Rigorous follow-up, including endoscopy and imaging at frequent intervals is recommended when radical resection is forgone.
Collapse
Affiliation(s)
- F Rouleau-Fournier
- Department of Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| | - C J Brown
- Department of Surgery, St. Paul's Hospital, Providence Health Care, Vancouver, BC
| |
Collapse
|
17
|
Dean M, Church J. The anatomy of transanal minimally invasive surgery: Perineal distances and transanal angles. Clin Anat 2018; 32:68-72. [PMID: 30098037 DOI: 10.1002/ca.23246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/28/2018] [Accepted: 08/01/2018] [Indexed: 11/11/2022]
Abstract
The recent interest in transanal, minimally invasive surgery has highlighted the importance of an in depth understanding of this complex region. We applied data from an anatomical study of the perineum to the concept of transanal minimally invasive surgery with the aim to describe more accurately anatomy relevant to this surgical technique. A consecutive series of adult patients undergoing colonoscopy were approached for consent to measure dimensions and angles of the perineum before the examination. Distances from the posterior margin of the anus to the coccyx, and the anterior margin of the anus to the posterior edge of the scrotum or introitus were measured. Then, using a pediatric proctoscope and a protractor, the anoperineal angle and the recto perineal angles were measured. The anorectal angle was derived from these measurements. Data is described using means and standard deviations. Measurements were obtained from 106 patients undergoing elective colonoscopy for average risk screening with no history of defecatory disorder. Posterior perineal length was similar in both sexes (4.5 cm ± 0.9 in women and 4.6 cm ±0.7 in men) but the anterior perineum was significantly shorter in women (2.5 ± 0.8). The mean anoperineal angle was 93° (±9), and mean rectoperineal angle was 73° (±9). These angles varied significantly between the sexes. The mean anorectal angle (derived) was 160° (±9), and did not differ significantly between the sexes. There was no correlation between the posterior perineal length and ano perineal, recto perineal, or anorectal angles. Limitations: small sample size. Anoperineal and recto perineal differ significantly between the sexes. Surgeons using transanal minimally invasive surgical techniques should expect to alter the alignment of their dissection accordingly. This study shows the magnitude of the differences that can exist. Clin. Anat. 32:68-72, 2019. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Meara Dean
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
18
|
Abstract
Transanal endoscopic surgery (TES) techniques encompass a variety of approaches, including transanal endoscopic microsurgery and transanal minimally invasive surgery. These allow a surgeon to perform local excision of rectal lesions with minimal morbidity and the potential to spare the need for proctectomy. As understanding of the long-term outcomes from these procedures has evolved, so have the indications for TES. In this study, we review the development of TES, its early results, and the evolution of new surgical techniques. In addition, we evaluate the most recent research on indications and outcomes in rectal cancer.
Collapse
Affiliation(s)
- Earl V Thompson
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Joshua I S Bleier
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| |
Collapse
|
19
|
García-Flórez LJ, Otero-Díez JL, Encinas-Muñiz AI, Sánchez-Domínguez L. Indications and Outcomes From 32 Consecutive Patients for the Treatment of Rectal Lesions by Transanal Minimally Invasive Surgery. Surg Innov 2017; 24:336-342. [PMID: 28355962 DOI: 10.1177/1553350617700803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility, safety, perioperative morbidity, and short-term outcomes of the transanal minimally invasive surgery (TAMIS) technique. METHODS This is a descriptive review of prospectively collected data from 32 consecutive patients who underwent TAMIS procedures in our colorectal unit over a 40-month period. GelPOINT Path port was used in all cases. Demographic data, indications, tumor characteristics, morbidity, and follow-up data were collected. Primary endpoints included feasibility, safety, perioperative morbidity, and resection quality. RESULTS Fifteen adenomas, 12 carcinomas, 1 gastrointestinal stromal tumor, and 1 neuroendocrine tumor were locally excised. Additionally, 3 pelvic abscesses were drained transanally using the TAMIS port. Mean distance from the anal verge was 5.6 ± 1.5 cm. Early postoperative complications occurred in 22%, with only one case of major complication (3.1%) requiring reoperation, and no postoperative mortality. Four carcinomas were understaged (33.3%) and 1 adenoma overstaged (6.7%) preoperatively. Three carcinomas were not suspected preoperatively (25%). Microscopic positive lateral margin was found in one case, and no affected deep margin was found. Fragmentation rate was 6.9%, 2 cases, both lesions over 20 cm2. In cases of fit patients with high-risk carcinomas, 2 underwent immediate salvage surgery and another 2 refused and were treated with adjuvant radiotherapy. With a median follow-up of 26 months, the overall recurrence rate was 10.3%, 1 adenoma and 2 carcinomas. CONCLUSION TAMIS seems to be a safe and reproducible procedure for local excision of well-selected rectal lesions with low morbidity and good functional outcomes.
Collapse
Affiliation(s)
- Luis J García-Flórez
- 1 Hospital Universitario San Agustín, Avilés, Spain.,2 University of Oviedo, Oviedo, Spain
| | | | | | | |
Collapse
|