Abstract
Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology.Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient.We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.
Highlights
Rectal cancer treatment has undergone a lot of changes in the past several decades
In the total mesorectal excision (TME) era, we learned that the other very important resection margin is the circumferential resection margin (CRM), as it is a clear predictor of both overall survival and the risk of local recurrence [7]
Despite a great number of studies on Transanal endoscopic microsurgery (TEM) and completion surgery for patients with high-risk rectal cancers, there are no clear recommendations on when to proceed with completion TME after TEM
Summary
Rectal cancer treatment has undergone a lot of changes in the past several decades. The most important change related to surgical technique was the introduction of the concept of total mesorectal excision [1]. Local treatment of rectal cancer was always an attractive alternative for early rectal cancer as it was related to low morbidity and mortality, a possibility of avoiding postoperative functional disturbances, and a permanent stoma in a proportion of patients with low rectal cancer. Buess in 1983 [4], or a later modification of this technique – transanal minimally invasive surgery (TAMIS) using standard laparoscopic equipment and a single-incision laparoscopic surgery port to access rectal lesions [5] – may improve some of the issues of the local excision, but the concept, when comparing it with radical surgery, remains similar. As a result of proper TEM, local full thickness excision of the rectal tumour may adversely affect the further possibility of creating an intact total mesorectal excision (TME) specimen and avoiding an intraoperative perforation of the rectum. Written informed consent regarding the use of personal data was taken from both patients
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