The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o...BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.展开更多
BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS ...BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious and challenging complication following low anterior resection(LAR)for low rectal cancer.This case series presents the successful management of AL in three patients using ...BACKGROUND Anastomotic leakage(AL)is a serious and challenging complication following low anterior resection(LAR)for low rectal cancer.This case series presents the successful management of AL in three patients using a combined approach of transanal opening of the intersphincteric space(TROPIS)surgery and adjuvant Kangfuxin liquid enema therapy.CASE SUMMARY Three male patients underwent laparoscopic LAR with diverting ileostomy for low rectal cancer.Case 1:A 39-year-old,presented with fever and abdominal distension 2 weeks after discharge.A digital rectal examination revealed partial anastomotic separation.Case 2:A 74-year-old,developed abdominal pain and fever on postoperative day 5,with fecal discharge through the pelvic drain,and computed tomography scan confirmed AL.Case 3:A 51-year-old,was asymptomatic but diagnosed with AL 1 week after discharge;despite 1 year of conservative management,the leakage failed to heal.All three patients were subsequently treated with TROPIS surgery combined with twice-daily Kangfuxin liquid enemas,resulting in complete resolution of AL in each case.CONCLUSION The combination of TROPIS and Kangfuxin enema appears to be a safe and effective approach for managing AL following LAR.This minimally invasive strategy offers a promising alternative to conventional surgical interventions.Further studies with larger cohorts are warranted to validate these findings.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and...BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.展开更多
BACKGROUND Transanal endoscopic intersphincteric resection(ISR)surgery currently lacks sufficient clinical research and reporting.AIM To investigate the clinical effectiveness of transanal endoscopic ISR,in order to p...BACKGROUND Transanal endoscopic intersphincteric resection(ISR)surgery currently lacks sufficient clinical research and reporting.AIM To investigate the clinical effectiveness of transanal endoscopic ISR,in order to promote the clinical application and development of this technique.METHODS This study utilized a retrospective case series design.Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included.All patients underwent transanal endoscopic ISR as the surgical approach.We conducted this study to determine the perioperative recovery status,postoperative complications,and pathological specimen charac-teristics of this group of patients.RESULTS This study included 45 eligible patients,with no perioperative mortalities.The overall incidence of early complications was 22.22%,with a rate of 4.44%for Clavien-Dindo grade≥III events.Two patients(4.4%)developed anastomotic leakage after surgery,including one case of grade A and one case of grade B.Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients.The mean distance between the tumor lower margin and distal resection margin was found to be 2.30±0.62 cm.The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens.CONCLUSION Transanal endoscopic ISR is safe,feasible,and provides a clear anatomical view.It is associated with a low incidence of postoperative complications and favorable pathological outcomes,making it worth further research and application.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To...BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.展开更多
BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by th...BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.展开更多
Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychologica...Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.展开更多
Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of beni...Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.展开更多
Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TE...Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.展开更多
AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r...AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.展开更多
AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patie...AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics,tumor characteristics,operative details,postoperative outcomes,pathologic findings,and follow-ups. RESULTS:Full-thickness excision using TEM was performed as a primary excision(n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy(n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm,and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min,and the mean blood loss was 13.5 ± 6.6 m L. No minor morbidities,transient fecal incontinence,or wound dehiscence was found. Histopathologically,all tumors showed typical histology without lymphatic or vessel infiltration,and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy,9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. Norecurrence was noted during the median of 3 years' follow-up.CONCLUSION:Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.展开更多
AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergo...AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.展开更多
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ...The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.展开更多
AIM To analyze the outcomes of transanal endoscopic microsurgery(TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a tw...AIM To analyze the outcomes of transanal endoscopic microsurgery(TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed.RESULTS Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males(57.7%) and 22 females(42.3%). Mean age was 55 years(median = 60, range = 24-78). This series included 14(26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors(40.4%), 1 ganglioneuroma(1.9%), 2 solitary ulcers in the rectum(3.8%), 6 cases of rectal endometriosis(11.5%), 6 cases of rectal condylomatosis(11.5%) and 2 rectal melanomas(3.8%). Mean lesion diameter was 2.7 cm(median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm(median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences(3.8%) with an overall survival equal to 97.6%(95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98%(95%CI: 96%-99%).CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions.展开更多
AIM:To assess midterm results of stapled transanal rectal resection(STARR)for obstructed defecation syndrome(ODS)and predictive factors for outcome.METHODS:From May 2007 to May 2009,75 female patients underwent STARR ...AIM:To assess midterm results of stapled transanal rectal resection(STARR)for obstructed defecation syndrome(ODS)and predictive factors for outcome.METHODS:From May 2007 to May 2009,75 female patients underwent STARR and were included in the present study.Preoperative and postoperative workup consisted of standardized interview and physical examination including proctoscopy,colonoscopy,anorectal manometry,and defecography.Clinical and functional results were assessed by standardized questionnaires for the assessment of constipation constipation scoring system(CSS),Longo’s ODS score,and symptom severity score(SSS),incontinence Wexner incontinence score(WS),quality of life Patient Assessment of Constipation-Quality of Life Questionnaire(PAC-QOL),and patient satisfaction visual analog scale(VAS).Data were collected prospectively at baseline,12 and 30 mo.RESULTS:The median follow-up was 30 mo(range,30-46 mo).Late postoperative complications occurred in 11(14.7%)patients.Three of these patients required procedure-related reintervention(one diverticulectomy and two excision of staple granuloma).Although the recurrence rate was 10.7%,constipation scores(CSS,ODS score and SSS)significantly improved after STARR(P<0.0001).Significant reduction in ODS symptoms was matched by an improvement in the PAC-QOL and VAS(P<0.0001),and the satisfaction index was excellent in 25(33.3%)patients,good in 23(30.7%),fairly good in 14(18.7%),and poor in 13(17.3%).Nevertheless,the WS increased after STARR(P=0.0169).Incontinence was present or deteriorated in 8(10.7%)patients;6(8%)of whom were new onsets.Univariate analysis revealed that the occurrence of fecal incontinence(preoperative,postoperative or new-onset incontinence;P=0.028,0.000,and 0.007,respectively)was associated with the success of the operation.CONCLUSION:STARR is an acceptable procedure for the surgical correction of ODS.However,its impact on symptomatic recurrence and postoperative incontinence may be problematic.展开更多
Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approa...Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS.展开更多
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
基金Supported by the Basic and Applied Basic Research Foundation of Guangzhou,No.202201011331the National Natural Science Foundation of China,No.82373118the Natural Science Foundation of Guangdong Province,No.2023A1515010828.
文摘BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.
文摘BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS.
文摘BACKGROUND Anastomotic leakage(AL)is a serious and challenging complication following low anterior resection(LAR)for low rectal cancer.This case series presents the successful management of AL in three patients using a combined approach of transanal opening of the intersphincteric space(TROPIS)surgery and adjuvant Kangfuxin liquid enema therapy.CASE SUMMARY Three male patients underwent laparoscopic LAR with diverting ileostomy for low rectal cancer.Case 1:A 39-year-old,presented with fever and abdominal distension 2 weeks after discharge.A digital rectal examination revealed partial anastomotic separation.Case 2:A 74-year-old,developed abdominal pain and fever on postoperative day 5,with fecal discharge through the pelvic drain,and computed tomography scan confirmed AL.Case 3:A 51-year-old,was asymptomatic but diagnosed with AL 1 week after discharge;despite 1 year of conservative management,the leakage failed to heal.All three patients were subsequently treated with TROPIS surgery combined with twice-daily Kangfuxin liquid enemas,resulting in complete resolution of AL in each case.CONCLUSION The combination of TROPIS and Kangfuxin enema appears to be a safe and effective approach for managing AL following LAR.This minimally invasive strategy offers a promising alternative to conventional surgical interventions.Further studies with larger cohorts are warranted to validate these findings.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
基金This study is registered at clinicaltrials.gov.The registration identification number is NCT05627999.
文摘BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes.
文摘BACKGROUND Transanal endoscopic intersphincteric resection(ISR)surgery currently lacks sufficient clinical research and reporting.AIM To investigate the clinical effectiveness of transanal endoscopic ISR,in order to promote the clinical application and development of this technique.METHODS This study utilized a retrospective case series design.Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included.All patients underwent transanal endoscopic ISR as the surgical approach.We conducted this study to determine the perioperative recovery status,postoperative complications,and pathological specimen charac-teristics of this group of patients.RESULTS This study included 45 eligible patients,with no perioperative mortalities.The overall incidence of early complications was 22.22%,with a rate of 4.44%for Clavien-Dindo grade≥III events.Two patients(4.4%)developed anastomotic leakage after surgery,including one case of grade A and one case of grade B.Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients.The mean distance between the tumor lower margin and distal resection margin was found to be 2.30±0.62 cm.The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens.CONCLUSION Transanal endoscopic ISR is safe,feasible,and provides a clear anatomical view.It is associated with a low incidence of postoperative complications and favorable pathological outcomes,making it worth further research and application.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.
文摘BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail patients.AIM To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United Kingdom.METHODS TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological outcomes.This is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail patients.RESULTS Two hundred and twenty-two patients underwent TEMS surgery.This included 144 males(64.9%)and 78 females(35.1%),Median age was 71 years.The median distance of the tumours from the anal verge 4.5 cm.Median tumour size was 2.6 cm.The most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 patients.Median operating time was 90 minutes.Average blood loss was minimal.There were two 90-day mortalities.Complete excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding cancers.Full-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.
基金Supported by National Natural Science Foundation of China,No.81500505 and No.81570492Natural Science Foundation of Hubei Province of China,No.2015CFB636
文摘Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented.
文摘Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained.
文摘Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.
文摘AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception.
文摘AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics,tumor characteristics,operative details,postoperative outcomes,pathologic findings,and follow-ups. RESULTS:Full-thickness excision using TEM was performed as a primary excision(n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy(n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm,and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min,and the mean blood loss was 13.5 ± 6.6 m L. No minor morbidities,transient fecal incontinence,or wound dehiscence was found. Histopathologically,all tumors showed typical histology without lymphatic or vessel infiltration,and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy,9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. Norecurrence was noted during the median of 3 years' follow-up.CONCLUSION:Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors.
文摘AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.
文摘The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.
文摘AIM To analyze the outcomes of transanal endoscopic microsurgery(TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma. METHODS We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed.RESULTS Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males(57.7%) and 22 females(42.3%). Mean age was 55 years(median = 60, range = 24-78). This series included 14(26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors(40.4%), 1 ganglioneuroma(1.9%), 2 solitary ulcers in the rectum(3.8%), 6 cases of rectal endometriosis(11.5%), 6 cases of rectal condylomatosis(11.5%) and 2 rectal melanomas(3.8%). Mean lesion diameter was 2.7 cm(median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm(median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences(3.8%) with an overall survival equal to 97.6%(95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98%(95%CI: 96%-99%).CONCLUSION We could conclude that TEM is an important therapeutical option for rectal rare conditions.
基金Supported by Clinical Research Fund of Beijing Municipal Science and Technology Commission,No.Z111107058811051
文摘AIM:To assess midterm results of stapled transanal rectal resection(STARR)for obstructed defecation syndrome(ODS)and predictive factors for outcome.METHODS:From May 2007 to May 2009,75 female patients underwent STARR and were included in the present study.Preoperative and postoperative workup consisted of standardized interview and physical examination including proctoscopy,colonoscopy,anorectal manometry,and defecography.Clinical and functional results were assessed by standardized questionnaires for the assessment of constipation constipation scoring system(CSS),Longo’s ODS score,and symptom severity score(SSS),incontinence Wexner incontinence score(WS),quality of life Patient Assessment of Constipation-Quality of Life Questionnaire(PAC-QOL),and patient satisfaction visual analog scale(VAS).Data were collected prospectively at baseline,12 and 30 mo.RESULTS:The median follow-up was 30 mo(range,30-46 mo).Late postoperative complications occurred in 11(14.7%)patients.Three of these patients required procedure-related reintervention(one diverticulectomy and two excision of staple granuloma).Although the recurrence rate was 10.7%,constipation scores(CSS,ODS score and SSS)significantly improved after STARR(P<0.0001).Significant reduction in ODS symptoms was matched by an improvement in the PAC-QOL and VAS(P<0.0001),and the satisfaction index was excellent in 25(33.3%)patients,good in 23(30.7%),fairly good in 14(18.7%),and poor in 13(17.3%).Nevertheless,the WS increased after STARR(P=0.0169).Incontinence was present or deteriorated in 8(10.7%)patients;6(8%)of whom were new onsets.Univariate analysis revealed that the occurrence of fecal incontinence(preoperative,postoperative or new-onset incontinence;P=0.028,0.000,and 0.007,respectively)was associated with the success of the operation.CONCLUSION:STARR is an acceptable procedure for the surgical correction of ODS.However,its impact on symptomatic recurrence and postoperative incontinence may be problematic.
基金supported by National Key R&D Program of China(No.2017YFC0908203)Chinese Academy of Medical Sciences Initiative for Innovative Medicine(No.2017-I2M-2-003 and 2016-I2M-1-001)+2 种基金Science and Technology Project of Chaoyang District,Beijing(No.CYSF-1931)Beijing Science and Technology Program(No.D17110002617004)Beijing Gold-Bridge Funds(No.ZZ19055)。
文摘Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS.
