Abstract
PurposeTo assess the feasibility and short-term outcomes of neoadjuvant chemoradiotherapy (CCRT) followed by transanal total mesorectal excision assisted by single-port laparoscopic surgery (TaTME-SPLS) for low-lying rectal adenocarcinoma.Methods and materialsA total of 23 patients with clinical stage II-III low-lying (from anal verge 0-8 cm) rectal adenocarcinoma who underwent neoadjuvant CCRT followed by TaTME-SPLS consecutively from December 2015 to December 2018, were enrolled into our study. Chi-squared testing and Student’s t testing were used to make parametric comparisons, and Fisher’s exact test or the Mann–Whitney U test were used to make nonparametric comparisons.ResultsConversion rate in patients who underwent neoadjuvant CCRT followed by TaTME-SPLS was only 4%. The mean operation time was 366 min and the inter-sphincter resection (ISR) was done for 14 patients (60%). The mean number of lymph nodes harvested was 15. There was no surgical mortality, but the 30-day morbidity rate was 21% (5 patients were Clavien-Dindo I-II). Pathological complete response was 21.74% with 100% organ preservation and 100% clear distal margin after neoadjuvant CCRT followed by TaTME-SPLS.ConclusionTaTME-SPLS would be highly successful in lymph node negative and low T stage of low-lying rectal cancer patients who had pathological complete remission or high percentage of partial remission after neoadjuvant CCRT.
Highlights
Laparoscopic colon resection has been considered as an alternative procedure to open colon resection after a series of randomized controlled trials (RCTs) from 2004 to 2005, with short-term advantages, like less morbidity and hospital stay, but similar long-term survival [1,2,3]
A total of 23 patients underwent neoadjuvant CCRT followed by Transanal total mesorectal excision (TaTME)-SPLS, and one patient underwent open total mesorectal excision (TME)
Patient characteristics were as follows: 56.52% were male patients, 82.61% had American Society of Anesthesiologists (ASA) score 2, the median distance from the anal verge was 52 mm, the median tumor size was 20 mm, 65.22% were at The American Joint Committee on Cancer (AJCC) clinical stage III, 91.30% were at cT3, and 47.83% were at cN1; the characteristics of our patients were compatible with only one TaTME-SPLS study done in France [18]
Summary
Laparoscopic colon resection has been considered as an alternative procedure to open colon resection after a series of randomized controlled trials (RCTs) from 2004 to 2005, with short-term advantages, like less morbidity and hospital stay, but similar long-term survival [1,2,3]. There have been controversial conclusions regarding laparoscopic total mesorectal excision (TME) and open TME in patients with rectal cancer [1,2,3,4,5,6,7]. With progression in contemporary surgical techniques and equipment, laparoscopic TME was found to be safe and equivalent in terms of long-term outcomes, compared with open TME in 2 RCTs from 2014 to 2015 [4, 5]. Laparoscopic TME has still been a surgical challenge for middle and low rectal cancer, which requires surgeons experienced with high-volume of cases for treatment of selective patients [8]. Previous studies still have some unsolved problems regarding laparoscopic TME [4,5,6,7]
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