Resección total del mesorrecto por vía transanal en cáncer de recto. Análisis de resultados de una serie preliminar en un hospital universitario

Abstract

IntroductionTransanal total mesorectal excision is a hybrid approach that combines the use of a conventional laparoscopic and a transanal platform. ObjectivesTo conduct an analysis of selected cases with medium and lower rectal cancer, were a combined transanal approach was used and description of the surgical technique. Materials and methodsProspective series of patients diagnosed with middle and lower third rectal cancer with mesorectal resection assisted by endoanal single port, between October 2012 and December 2015 at University of Chile Clinical Hospital. Descriptive statistics were used for data analysis. ResultsA total of 29 patients underwent surgery for middle and lower rectal cancer using a transanal single port. Gender distribution was 22 male and 7 female patients, with a mean age of 55.5 years and a mean BMI of 26.4. The mean distance from the anal margin was 4.8cm. All patients received neoadjuvant therapy. The surgeries performed were 17 Ta-TME (58.6%) and 12 Ta-TME with intersphincteric approach (41.4%). The colo-anal anastomosis was hand sewn in 15 patients (51.7%), and stapled in 14 (48.3%). The laparoscopic approach was used in 26 patients and the open approach in 3, with 4 conversions (15.4%). The mean operative time was 282min. The mean hospital stay was 9 days. ConclusionThe endoanal single port appears as a useful tool in total mesorectal dissection for its safety and feasibility. We believe we need randomized prospective studies, where comparison of oncological and functional long-term results is relevant.