Shinichiro Mori, MD, PhD, Yoshiaki Kita, MD, PhD, Kan Tanabe, MD, PhD, Kenji Baba, MD, PhD, Masayuki Yanagi, MD, Tetsuya Ijichi, MD, Masumi Wada, MD, Takaaki Arigami, MD, PhD, Yasuto Uchikado, MD, PhD, Hiroshi Kurahara, Masahiko Sakoda, MD, PhD, Kosei Maemura, MD, PhD, Shoji Natsugoe, MD, PhD. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medicine, Kagoshima University
Aim: Multiple advantage for transanal total mesorectum excision (TaTME) have been reported. The aim of this study was to evaluate the safety and short-term outcomes of patients who underwent TaTME based on embryology for rectal cancer.
Methods: We evaluated prospectively collected data of 70 consecutive patients with rectal cancer who underwent TaTME based on embryology from November 2014 to August 2018. Intraoperative complications, blood loss, postoperative complications, length of hospital stay, and pathological findings were assessed.
Surgical procedure: After setting the anal retractor, anal dilators were used for atraumatic introduction of the transanal access device (GelPOINT path). Three 10-mm trocars and one 15-mm trocar (AirSeal Access Port) were inserted through the access device in the form of a quadrant. The access device was then introduced through the anus to the rectum. After temporarily clamping the rectosigmoid using an atraumatic endo bulldog clip, pneumopelvis was maintained at 15 mmHg with carbon dioxide via an AirSeal platform. A double purse-string suture was applied in a clockwise manner using 0-0 polypropylene with a 26-mm rounded needle to tightly occlude the rectum with a 3-cm margin distal to the tumor, thus avoiding contamination by tumor cells and facilitating rectal transection. After irrigation with saline and marking of the dissection line by tattooing the rectal mucosa distal to the mucosal folds, mucosal dissection of the rectum was initiated. Full-thickness rectal transection was performed circumferentially. Dissection performed between endopelvic fascia and mesorectal fascia for posteriol wall; Denonvillier fascia and mesorectal fascia for anterior wall; the pelvic nerve and mesorectal fascia for both side wall with recognition of mobility between tissues of different embryological origins. The dissection proceeded toward the peritoneal reflex along the mesorectal fascia in a circumferential manner until connect to abdominal phase.
Results: A total of 33, 25 and 12 patients underwent simultaneous laparoscopic low anterior resection, partial intersphincteric resection and Hartmann operation, respectively. Intraoperative complications occurred in 2 patients. The mean operative time and amount of blood loss were 325 min and 72 g, respectively. The overall postoperative complications rate was 20.0%, including 2 patients with Clavien Dindo classification grade IIIb. The mean length of hospital stay was 14 days. The mean number of retrieved lymph nodes was 19.4. The mean distal margin was 2.9 cm. CRM positive rate was 2.8 %.
Conclusions: TaTME based on embryology for rectal cancer is safety and usefully for patients with rectal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95461
Program Number: S130
Presentation Session: Colorectal III
Presentation Type: Podium