Open Total Mesorectal Excision Research Articles

Efficiency of the Robotic Platform in Improving the Rate of Sphincter Preservation in Patients With Mid and Low Rectal Cancer.

The aim of this study was to investigate whether the robotic platform can have a positive impact on the rate of sphincter preservation in patients with rectal tumors, undergoing robotic total mesorectal excision (TME), in comparison with laparoscopic or open TME. We also analyzed and compared short-term outcomes. A prospectively collected robotic database was reviewed and compared with the trust and national data. Three groups were designed according to the surgical technique: open, laparoscopic and robotic. This includes all resections for mid and low rectal cancer which were performed with the robotic platform, over a period of 4 years, versus the trust data for the same period. Two hundred ninety-seven patients with mid and low rectal cancers were analyzed. Demographics for the groups (gender, age, and body mass index) were similar but distance from anal verge was shorter in the robotic group (7 vs. 8.5 cm, P < 0.001). The percentage of abdominoperineal resection (APR) rate was significantly lower in the robotic group (13.5% vs. 39.6% vs. 52.4% for the open group, P < 0.001). Median length of stay, complication rate, and positive circumferential resection margin (CRM) rate for the robotic group were also statistically significantly lower than those for both laparoscopic and open groups. Robotic surgery for mid and low rectal cancer is safe and feasible, and could help surgeons perform ultra-low anterior resections, rather than APRs and save patients' sphincters. Positive CRM is low, which could lead to improved oncological outcomes.

Transanal Total Mesorectal Excision for Adults With Rectal Cancer

&#x0D; Transanal total mesorectal excision may result in lower rates of conversion to open procedure and a better circumferential resection margin compared with laparoscopic total mesorectal excision in adults with rectal cancer.&#x0D; Transanal total mesorectal excision may be comparable to laparoscopic total mesorectal excision for cancer recurrence, survival, death, and short-term safety outcomes in adults with rectal cancer.&#x0D; Total mesorectal excision may be more cost-effective than laparoscopic and open total mesorectal excision in adults with rectal cancer, but this is uncertain.&#x0D;

The Multidisciplinary Approach of Rectal Cancer: The Experience of "COMRE Group" Model.

Background: Total mesorectal excision (TME) is the gold standard to treat locally advanced rectal cancer. This monocentric retrospective study evaluates the results of laparotomic, laparoscopic and robotic surgery in “COMRE GROUP” (REctalCOMmittee). Methods: 327 selected stage I-II-III patients (pts) underwent TME between November 2005 and April 2020 for low or middle rectal cancer; 91 pts underwent open, 200 laparoscopic and 36 robotic TME. Of these, we analyzed the anthropomorphic, intraoperative, anatomopathological parameters and outcome during the follow up. Results: The length of hospital stay was significantly different between robotic TME and the other two groups (8.47 ± 3.54 days robotic vs. 11.93 ± 5.71 laparotomic, p < 0.001; 8.47 ± 3.54 robotic vs. 11.10 ± 7.99 laparoscopic, p < 0.05). The mean number of harvested nodes was higher in the laparotomic group compared to the other two groups (19 ± 9 laparotomic vs. 15 ± 8 laparoscopic, p < 0.001; 19 ± 9 laparotomic vs. 15 ± 7 robotic, p < 0.05). Median follow-up was 52 months (range: 1–169). Overall survival was significantly shorter in the open TME group compared with the laparoscopic one (Chi2 = 13.36, p < 0.001). Conclusions: In the experience of the “COMRE” group, laparoscopic TME for rectal cancer is a better choice than laparotomy in a multidisciplinary context. Robotic TME has a significant difference in terms of hospital stay compared to the other two groups.

Outcomes in open rectal cancer surgery; five-year local recurrence and survival rates in a District General Hospital setting, a retrospective cohort study

IntroductionFollowing treatment for rectal cancer, outcomes in the UK include a 5-year survival rate of around 60%, and a variable 5-year local recurrence rate. Surgical treatment involves Total Mesorectal Excision (TME), with laparoscopic and, more recently, robotic approaches gaining popularity over the open technique. The aim of this study was to compare outcomes of rectal cancer patients managed in a single District General Hospital to the documented UK averages for 5-year survival and 5-year local recurrence. MethodsA total of 64 consecutive patients undergoing open TME performed by a single surgeon at a single site between 2009 and 2015 were analysed retrospectively. Histopathological, radiological, and demographic data collected during 5 years of follow up were used to help establish a 5-year survival rate and a 5-year local recurrence rate. ResultsFor the 64 patients analysed, the 5-year survival rate was 74.6% and the 5-year local recurrence rate was 7.9%. ConclusionIn our cohort of patients undergoing open TME, the 5-year survival rate was higher than the documented UK average and the 5-year local recurrence rate lay within the published range. In addition, greater patient age and a shorter distance of the tumour from the anal verge were shown to have a significant correlation with increased mortality.

Comparison of postoperative laparoscopic and open total mesorectal excision on lower urinary tract function in men with rectal cancer.

This study investigated male voiding dysfunction (VD) or lower urinary tract function in rectal cancer (RC) patients after laparoscopic or open total mesorectal excision with pelvic autonomic nerve preservation (PANP). One hundred and eighty-seven male RC patients admitted between January 2016 and May 2019 were enrolled in this study, 112 of whom underwent laparoscopic total mesorectal excision (LTME) and 75 underwent open total mesorectal excision (OTME). The International Prostatic Symptom Score (IPSS) was compared between the two groups. The postoperative IPSS in patients with RC was elevated on day 7 and gradually decreased during the first month after surgery. Compared with the OTME group, the IPSS scores decreased less in the LTME group at week 1, and months 1 and 3 postoperatively (6.82 ± 2.13 vs 10.15 ± 3.86, 5.70 ± 2.45 vs 7.21 ± 2.0, and 5.01 ± 2.09 vs 5.75 ± 2.55, respectively; P < 0.05). The VD rate was significantly lower in the LTME group than the OTME group at 1, 2, and 3 weeks postoperatively (21.4% vs 26.8%,13.4% vs 25.3%, and 9.8% vs18.6%, respectively; P < 0.05); however, there was no major difference in the incidence of VD 6months postoperatively between the two groups (P > 0.05). VD was more frequent in the OTME group than the LTME group 6months postoperatively, but the difference was not statistically significant (odds ratio=1.857, 95% CI, 0.964-3.645, P=0.064). LTME may be superior to OTME with respect to PANP of lower urinary tract function in males with RC.

EP.TU.1069Improved Perioperative and Survival Outcomes for Minimally Invasive Rectal Surgery

Abstract Aim Although laparoscopic colon cancer surgery has been widely embraced as current evidence demonstrates comparable oncological results with open surgery, similar evidence is lacking for laparoscopic rectal cancer surgery. We present the outcomes of patients undergoing laparoscopic and open total mesorectal excision (TME) for rectal cancer in our unit. Methods We retrospectively analysed data collected for patients who underwent laparoscopic and open TME from January 2014 to December 2018. Sociodemographic, perioperative, circumferential resection margin (CRM) positivity, locoregional recurrence and survival data were analysed. Results 260 (144 laparoscopic and 116 open) were included. Median age in the laparoscopic group was 69 years and in the open group 68 years. Neoadjuvant therapy was given in 21 patients (14.6%) in laparoscopic and 13 (11.2%) in the open group (p = 0.42). CRM was positive in 16 cases (11.1%) laparoscopic and 32 (27.6%) open (p = 0.0007;95%CI:6.9-26.2). No statistically significant difference in anastomotic leak rate was observed both groups (4.9% laparoscopic vs 4.3% open;p=0.82). Surgical site infection was significantly more in open cases (13% vs 5.6% laparoscopic,p=0.04). Similar locoregional recurrence rates were observed in both groups (18% laparoscopic vs 19% open,p=0.84). Median follow up was 34 months or more allowed for Disease-free (DFS) and overall survival (OS) to be analysed for 144 of 260 patients. DFS and OS were better in laparoscopic (73% and 94%) compared to open (68% and 85% respectively) (p = 0.40 and p = 0.015 respectively). Conclusion From an oncological perspective, laparoscopic surgery for rectal cancer is safe with additional perioperative and survival benefits compared to open surgery.

Open versus laparoscopic lateral lymph node dissection for mid- and low- rectal cancer: a propensity score matching study.

This study aimed to evaluate the perioperative, pathological and oncological outcomes of open versus laparoscopic total mesorectal excision (TME) plus lateral lymph node dissection (LLND) for mid- and low- rectal cancer using propensity score matching. Between September 2009 and December 2018, consecutive patients who underwent open or laparoscopic TME plus LLND were collected. Based on the propensity score matching analysis, laparoscopic TME plus LLND was compared with open TME plus LLND for the perioperative, pathological, and oncological outcomes. A total of 77 patients were collected. There were 13 patients who underwent open TME plus LLND (open group) and 64 patients who underwent laparoscopic TME plus LLND (laparoscopic group). After propensity score matching, 13 patients in the open group were matched to 39 patients in the laparoscopic group (1:3). The laparoscopic group had a significantly shorter length of incision (5cm vs. 20 cm, p< 0.01), less intraoperative blood loss (80 mL vs. 100 mL, p= 0.02), and shorter time to postoperative liquid diet (72 h vs. 96 h, p= 0.05). There were no significant differences in both early and late postoperative complications. The 3-year overall survival was 85.9% in the laparoscopic group and 76.9% in the open group (p= 0.75), respectively. The 3-year disease-free survival was 70.6% in the laparoscopic group and 74.1% in the open group (p= 0.83), respectively. Laparoscopic LLND had comparable oncological outcomes to open LLND. Moreover, laparoscopic LLND had postoperative recovery advantages over open LLND.

Robotic rectal resection preserves anorectal function: Systematic review and meta-analysis.

Improving survival rates in rectal cancer patients has generated a growing interest in functional outcomes after total mesorectal excision (TME). The well-established low anterior resection syndrome (LARS) score assesses postoperative anorectal impairment after TME. Our meta-analysis is the first to compare bowel function after open, laparoscopic, transanal, and robotic TME. All studies reporting functional outcomes after rectal cancer surgery (LARS score) were included, and were compared with a consecutive series of robotic TME (n=48). Thirty-two publications were identified, including 5 565 patients. Anorectal function recovered significantly better within one year after robotic TME (3.8 [95%CI -9.709-17.309]) versus laparoscopic TME (26.4 [95%CI 19.524-33.286]), p=0.006), open TME (26.0 [95%CI 24.338-29.702], p=0.002) and transanal TME (27.9 [95%CI 22.127-33.669], p=0.003). Robotic TME enables better recovery of anorectal function compared to other techniques. Further prospective, high-quality studies are needed to confirm the benefits of robotic surgery.

Outcomes of robotic low anterior resection versus transanal total mesorectal excision for rectal cancer.

BackgroundThe quality of total mesorectal excision (TME) is regarded as a fundamental key to the oncological outcome of rectal cancer. Robotic low anterior resection (RLAR) and transanal TME (TaTME) were developed to overcome the technical challenges of conventional open TME. This study aimed to compare the short- and long-term outcomes of RLAR versus TaTME for rectal cancer.MethodsRetrospective data from patients undergoing RLAR or TaTME at a colorectal unit in Singapore were analysed. The primary outcomes were the short-term clinical and pathological results including specimen margins and quality of TME. Secondary outcomes were recurrence, disease-free survival (DFS), and overall survival rates.ResultsA total of 80 patients who underwent either RLAR or TaTME were analysed. The TaTME group had a shorter operating time than the RLAR group (354 versus 481 min respectively; P < 0.001) and fewer stays in the high-dependency and intensive care units (38.1 versus 73.7 per cent; P = 0.010). There was a higher rate of readmissions at 30 days in the TaTME group (19.0 versus 0 per cent; P = 0.006). Specimens from TaTME had greater proximal (14.0 versus 10.0 cm; P = 0.045) and distal (2.50 versus 1.65 cm; P = 0.021) margins. Patients undergoing TaTME had borderline longer DFS (25.9 versus 15.7 months; P = 0.049). Subgroup analysis of patients with (y)pT3–4 tumours showed fewer positive circumferential resection margins with TaTME (0 versus 18.2 per cent; P = 0.019) and improved DFS (25.9 versus 15.7 months; P = 0.017).ConclusionSuperior margins were obtained with TaTME, especially in locally advanced tumours, although TaTME was associated with a higher readmission rate compared with RLAR.

A nationwide comparison of short-term outcomes after transanal, open, laparoscopic, and robot-assisted total mesorectal excision.

Laparoscopic rectal cancer surgery has several limitations. Transanal total mesorectal excision (TaTME) can potentially overcome these limitations. The aim of this study was to compare the rates of non-radical surgery and anastomotic leakage after TaTME, open TME (OpTME), laparoscopic TME (LaTME) and robotic TME (RoTME) procedures in a nationwide cohort. We extracted the demographic, perioperative and pathological data of patients who underwent a curative OpTME, LaTME, RoTME or TaTME procedure between January 2014 and December 2018 from the national database of the Danish Colorectal Cancer Group (DCCG). We conducted multiple group-comparisons, uni- and multivariate analyses to determine the factors associated with positive resection margin (+RM) and anastomotic leakage. We included 2393 patients (OpTME = 205, LaTME = 1163, RoTME = 713 and TaTME = 312). The rate of +RM was 5.7% after TaTME. The lowest rate of +RM was achieved after RoTME (8.2%, 4.7%, 2.52%, and 5.7%, after OpTME, LaTME, RoTME and TaTME respectively, p<0.001). In multivariate analysis, having a T4 tumour and intraoperative bowel perforation were associated with the risk of +RM (p<0.001, p<0.001, respectively). The factors associated with anastomotic leakage in multivariate analysis were male gender, high BMI and intraoperative bowel perforation (p<0.001, p=0.049, p=0.002, respectively). TaTME was associated with the highest rate of sphincter-saving procedures (79.8%, p<0.001), the lowest rate of bowel perforation (2.9%, p=0.028) and the lowest rate of conversion to open surgery (1.3%, p<0.001). In a nationwide audit of TME approaches, the rate of +RM was lowest after RoTME. No differences were found between the four approaches regarding the risk of anastomotic leakage. TaTME offered advantages related to sphincter-saving, perforation and conversion.

Sponge Single-port Laparoscopy-assisted Transanal Total Mesorectal Excision for Low Rectal Cancer: a Technical Report

Laparoscopic colorectal surgery is a surgical technique as safe as open surgery. Transanal total mesorectal excision (TaTME), which is a new approach in rectum surgery, is the resection of the rectum with the perianal approach with the help of endoscopic instruments. Although there are specially designed tools for this approach, it can also be done with the help of other options. Our patient, who we prepared for the operation with the diagnosis of rectal cancer, was operated with a standard technique using a manually prepared sponge-port during the Coronavirus disease-19 pandemic period. After resection, the specimen was taken out transrectally, coloanal anastomosis was performed with 2/0 vicryl one by one, and the operation was completed with a protective ileostomy. Operation time was 245 minutes. The patient who did not develop postoperative complications was discharged on the 5th day. The wide series results should be followed in order to compare the oncological and clinical results of TaTME with open and standard laparoscopic TME results, which allows to perform the tumor surgical margin macroscopically with the dissection.

AB017. SOH21AS078. Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal total mesorectal excision (TME) approaches

AB017. SOH21AS078. Surgical approach for rectal cancer: a network meta-analysis comparing open, laparoscopic, robotic and transanal total mesorectal excision (TME) approaches

Robotic Total Mesorectal Excision for Rectal Cancer: Short-Term Oncological Outcomes of Initial 178 Cases

Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon.

Short- and long-term outcomes of laparoscopic versus open lateral lymph node dissection for locally advanced middle/lower rectal cancer using a propensity score-matched analysis.

There are few reports on large-scale trials for the long-term outcomes regarding laparoscopic lateral lymph node dissection (LLND). We evaluated the short- and long-term outcomes of laparoscopic versus open LLND for locally advanced middle/lower rectal cancer using a propensity score-matched analysis. From January 2005 to December 2016, consecutive clinical stage II to III middle/lower rectal cancer patients who underwent total mesorectal excision (TME) plus LLND were retrospectively collected at three institutions. Laparoscopic LLND was compared with open LLND for the surgical and oncological outcomes, including the long-term survival, using a propensity score-matched analysis. A total of 325 patients were collected. There were 142 patients who underwent open TME plus LLND (open group) and 183 patients who underwent laparoscopic TME plus LLND (laparoscopic group). A total of 93 patients each were matched to each group. Compared to the open group, the laparoscopic group had a significantly longer operative time (327 vs. 377min; p = 0.002) but significantly less blood loss (540 vs. 50ml; p < 0.001), fewer Clavian-Dindo grade ≥ 2 postoperative complications (49.5% vs. 34.4%; p = 0.037) and shorter postoperative hospital stay (18 vs. 14days; p = 0.008). Furthermore, the rate of urinary retention was significantly lower in the laparoscopic group than in the open group (16.1% vs. 6.5%; p = 0.037). The estimated 3-year overall survival, relapse-free survival, and cumulative incidence of local recurrence were 91.4%, 73.1%, and 3.4% in the open group and 90.3%, 74.2%, and 4.3% in the laparoscopic group (p = 0.879, 0.893, 0.999), respectively. This study showed that laparoscopic LLND had advantages over an open approach, such as less blood loss, fewer postoperative complications, and a shorter postoperative hospital stay, and the oncologic outcomes were similar to the open approach. Laparoscopic LLND could be a viable standard approach to LLND for advanced middle/lower rectal cancer surgery.

Surgical approach for rectal cancer: A network meta-analysis comparing open, laparoscopic, robotic and transanal TME approaches

BackgroundThe optimal approach for total mesorectal excision (TME) of rectal cancer remains controversial. AimTo compare short- and long-term outcomes after open (OpTME), laparoscopic (LapTME), robotic (RoTME) and transanal TME (TaTME). MethodsA systematic search of electronic databases was performed up to January 1, 2020 for randomized controlled trials (RCTs) comparing at least 2 TME strategies. A Bayesian arm-based random effect network meta-analysis (NMA) was performed, specifically, a mixed treatment comparison (MTC). Results30 RCTs (and six updates) of 5586 patients with rectal cancer were included. No significant differences were identified in recurrence rates or survival rates. Operating time was shorter with OpTME (surface under the cumulative ranking curve [SUCRA] 0.96) compared to LapTME, RoTME and TaTME. Although OpTME was associated with the most blood loss (SUCRA 0.90) and had a slower recovery with increased length of stay (SUCRA 0.90) compared to the minimally invasive techniques, there was no difference in postoperative morbidity. OpTME was associated with a more complete TME specimen compared to LapTME (Risk Ratio [RR] 1.05, 95% Credible Interval [CrI] 1.01, 1.11), and TaTME had less involved CRMs (RR 0.173, 95% CrI 0.02, 0.76) versus LapTME. There were no differences between the modalities in terms of deep TME defects, DRM distance, or lymph node yield. ConclusionsWhile OpTME was the most effective TME modality for short term histopathological resection quality, there was no difference in long-term oncologic outcomes. Minimally invasive approaches enhance postoperative recovery, at the cost of longer operating times. Technique selection should be based on individual tumour characteristics and patient expectations, as well as surgeon and institutional expertise.

Study of anorectal dynamics in patients undergoing laparoscopic ultra-low resection and transanal intersphincteric resection for rectal cancer.

Quite a few studies on anal functions after open total mesorectal excision combined with transanal intersphincteric resection (ISR) have been reported, but there is little literature on anal function after laparoscopic total mesorectal excision (LTME) combined with transanal ISR. The aim of this study was to explore the post-operative anorectal dynamic changes in ultra-low rectal cancer patients undergoing LTME combined with transanal ISR. The data of 26 ultra-low rectal cancer patients undergoing LTME + transanal ISR were analysed. A total of 30 patients undergoing laparoscopic low anterior resection by the same surgeons during the same period were randomly enrolled into the control group. There were no differences in the preoperative anorectal manometry data and Wexner anal function scores between the observation group and the control group (P > 0.05). There were no significant differences in the mean operation time, the mean amount of bleeding and the mean post-operative hospital stay between the two groups (P > 0.05). The mean follow-up time was 16 months. No recurrence and metastasis were found in all cases. At 3 and 6 months after the operation, there were significant differences in the anorectal manometry data and Wexner anal function scores between the two groups (P < 0.05). However, at 1 year after the operation, there were no significant differences in the anorectal manometry data and Wexner anal function scores between the two groups (P > 0.05). Laparoscopic ISR for ultra-low rectal cancer is technically feasible, but the surgical indications should be strictly defined.

Laparoscopic versus open selective lateral pelvic lymph node dissection following total mesorectal excision for locally advanced low rectal cancer.

Lateral pelvic lymph node (LPLN) dissection represents a technically challenging procedure with a high potential risk of surgical morbidity. The purpose of this study was to compare the technical feasibility, safety, and oncological efficacy of laparoscopic LPLN dissection (LPLD) following total mesorectal excision (TME) with open LPLD for locally advanced low rectal cancer (LALRC). Between January 2010 and December 2016, consecutive patients with LALRC and swollen LPLNs who underwent laparoscopic or open TME with LPLD at our institution were enrolled in this retrospective observational study. Data regarding patient demographics, perioperative characteristics, and oncological outcomes were analyzed and compared. A total of 64 patients met the inclusion criteria. Thirty-four patients underwent open procedure, and 30 underwent laparoscopic procedure. The mean blood loss volume was significantly less in the laparoscopic group than in the open group (165 vs. 422mL; P = 0.012). The mean operative time was not significantly different between the laparoscopic and the open groups (354 ± 91 vs. 315 ± 78min; P = 0.522). The overall postoperative complication rates were 30.0% and 35.3% for the laparoscopic and open groups (P = 0.428), respectively. Postoperative urinary retention was significantly less in the laparoscopic group than in the open group (14.7 vs. 0%; P = 0.036).The duration of postoperative hospital stay was significantly shorter in the laparoscopic group (8.5 ± 3.8 vs. 13.6 ± 6.5days; P = 0.025). The numbers of harvested lymph nodes and positive resection margin rates showed no significant differences. Pathological LPLN metastases were confirmed in 10 patients (29.4%) in the open group and 11 (36.7%) in the laparoscopic group (P = 0.537). The median follow-up duration was 41.5months (range 3-98). The laparoscopic and open groups also showed a similar 3-year overall survival rate (88.2% vs. 85.3%; P = 0.577), relapse-free survival rate (73.3% vs. 67.6%; P = 0.889), and local recurrence rate (3.3 vs. 5.9%; P = 0.653). Laparoscopic TME with LPLD is technically feasible and safe in selected patients with LALRC and is associated with similar oncological outcomes as open approach.

LAPAROSCOPIC, OPEN AND TRANSANAL MESORECTAL EXCISION IN RECTAL CANCER SURGERY

INTRODUCTION: there are no studies comparing laparoscopic, open, and transanal mesorectal excision for rectal cancer.AIM: to compare quality of total mesorectal excision (TME) according to the P. Quirke protocol, to assess circular resection margins (CRM), to assess distal resection margins (DRM) and perioperative morbidity.PATIENTS AND METHODS: prospective study was performed to compare the effectiveness of different methods of TME.RESULTS: eighty-eight patients were included in the study, 29 – in the laparoscopic (LA TME) group, 29 – in the open TME group, 30 – in the transanal (TA TME) group. The groups were comparable in clinical, demographic and tumor parameters. There was no significant difference between LA TME, open TME and TA TME in quality of mesorectal excision (p=0.67). There was also no significant difference in rates of positive CRM and positive DRM (p=0.38). No significant difference was obtained between intraoperative and postoperative complications rates (p=0.38; p=0.45). CONCLUSION: all three methods of TME showed the same results for quality, circular and distal resection margins and perioperative morbidity.

TOTAL MESORECTUMECTOMY IN THE SURGICAL TREATMENT OF RECTAL CANCER: OPEN OR LAPAROSCOPIC?

The OBJECTIVE of the work was to evaluate the long-term results of surgical treatment of patients underwent open and laparoscopic TME for rectal cancer.MATERIAL AND METHODS. The analysis of the results of surgical treatment of 103 patients aged from 20 to 70 years with rectal cancer was presented. Depending on the methods of total mesorectumectomy (ТМЕ), patients were divided into 2 groups. The 1st group included 47 (45.6 %) patients who had underwent laparoscopic total mesorectumectomy (LTME). The 2nd group included 56 patients who had underwent open total mesorectumectomy (OTME). In all patients, the histological structure of the tumor was represented by adenocarcinoma of varying degrees of differentiation. Long-term results of surgical treatment with actual and relapse-free 3-and 5-years survival were observed in 97 (94.2 %) patients.RESULTS. The frequency of local relapses of RC after OTME and LTME was 11.5 % (6 patients) and 11.1 % (5 patients). Distant metastases were detected in 7.7 (4 patients) and 6.7 % (3 patients) of cases, respectively. The actual 3-year survival rate of patients after LTME was 80 %/, 5-year-57.8 %. In patients underwent OTME, these indicators were 81.8 and 54.5 %, respectively.CONCLUSION. A significant correlation was found between the recurrence rate and distant metastases of the RC and the histological structure and degree of tumor differentiation. The differences between the three-year survival rates of patients in both groups are not statistically significant (p&gt;0.05).The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Comparison of pathological outcomes after transanal versus laparoscopic total mesorectal excision: a prospective study using data from randomized control trial.

Total mesorectal excision (TME) is the standard procedure for middle lower rectal cancer, and transanal total mesorectal excision (taTME) was founded as a valid alternative to the open and laparoscopic TME. The quality of the procedure performed is important for prognosis of patients. This study was designed to compare the pathological results of taTME with those of laparoscopic TME (laTME), based on the data from a randomized control trial (RCT: NCT02966483). Between April 2016 and November 2018, all rectal cancer patients who underwent taTME or laTME in the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) and enrolled in the RCT were included in this study. The data from all participants were prospectively input in a standardized database. In total 128 patients were included in the taTME group and 133 patients were included in the laTME group. The demographics and tumor characteristics were not significantly different between the two group. T3 or N0 lesions were most common in both groups. The mesorectum specimen was complete or nearly complete in all patients. The positive distal resection margin (DRM) was detected in 2 (1.5%) cases in the laTME group versus no cases in the taTME group (P = 0.498), and the distance between the tumor and DRM in the taTME group (1.4 ± 1.1) may have the longer tendency than that in the laTME group (1.3 ± 0.9) (P = 0.745). The positive circumferential resection margin was detected in 2 cases in each group (P = 0.674). The median number of resected lymph nodes was 15.0 in taTME group versus 16.0 in the laTME group (P = 0.069). The pathological outcomes between transanal and laparoscopic total mesorectal excision are similar. The rate of positive resection margin could not be significant decreased, nonetheless the decrease trend could be shown.