Sung Chan Park,, Dae Kyung Sohn, Min Jung Kim, Kyung Su Han, Hee Jin Chang, Jae Hwan Oh. National Cancer Center
Transabdominal approach for resection of low rectal tumor has been considered as a highly demanding procedure because of the confined anatomy and bony angulations particularly in males with a narrow pelvis or obese patients. For this reason, many surgeons tried “down-to-up” transanal approach for rectal dissection. The objective of this study was to evaluate the safety and the efficacy of transanal total mesorectal excision (TME).
METHODS AND PROCEDURES
Twelve patients with node negative rectal cancer located 4-12cm from the anal verge were enrolled in this pilot study. We used GelPOINT® Path (Applied Medical) for transanal approach. For transabdominal approach, Octoport™ (Dalim) was used at the presumed ileostomy site, and additional ports were used if necessary. The primary endpoint was TME quality and secondary endpoints were 30-day postoperative complications, number of harvested lymph nodes, and oncologic outcomes (2-year local recurrence free survival, 5-year survival).
From September 2013 to October 2014, 7 male patients and 5 female patients underwent transanal TME. The tumors were located in 6.7±2.1cm from the anal verge, and 4 (33.3%) of the patients underwent preoperative chemoradiotherapy. Mean age of patients was 62.3±10.1, and BMI was 24.5±2.8. Mean operation time was 119.2±48.5min, and estimated blood loss was 117.8±135.5ml, and there was no intraoperative complication and conversion.
Pathologic examination showed 11 cases (91.7%) of complete or near complete TME quality, and 1 case of incomplete TME quality. Distal resection margin and circumferential resection margin were 2.6±2.4cm, and 9.5±0.4mm respectively. Mean number of harvested lymph nodes was 15.8±4.0
Mean length of hospital stay was 11.6±5.0 days. There was no postoperative mortality, and minor postoperative complication occurred in 6 patients. All the complications were Clavien-Dindo Grade I or II, including 2 cases of urinary dysfunction, 3 cases of postoperative transient ileus, and 1 case of wound abscess.
In this pilot study, a high-quality of TME was possible in most of patients without serious complication. Transanal TME for rectal cancer patients was feasible and oncolongically safe procedure. Further investigations are necessary to evaluate its long-term oncologic safety and to clarify its indications.