Ann Surg Treat Res.  2016 Oct;91(4):187-194. 10.4174/astr.2016.91.4.187.

Feasibility of transanal endoscopic total mesorectal excision for rectal cancer: results of a pilot study

• Oh JH
• Park SC
• Kim MJ
• Park BK
• Hyun JH
• Chang HJ
• Han KS
• Sohn DK

• KMID: 2354326
• DOI: http://doi.org/10.4174/astr.2016.91.4.187

Abstract

PURPOSE
To evaluate the feasibility of transanal total mesorectal excision (TME) in patients with rectal cancer.
METHODS
This study enrolled 12 patients with clinically node negative rectal cancer located 4-12 cm from the anal verge who underwent transanal endoscopic TME with the assistance of single port laparoscopic surgery between September 2013 and August 2014. The primary endpoint was TME quality; secondary endpoints included number of harvested lymph nodes and postoperative complications within 30 days (NCT01938027).
RESULTS
The 12 patients included 7 males and 5 females, of median age 59 years and median body mass index 24.2 kg/m². Tumors were located on average 6.7 cm from the anal verge. Four patients (33.3%) received preoperative chemoradiotherapy. Median operating time was 195 minutes and median blood loss was 50 mL. There were no intraoperative complications and no conversions to open surgery. TME was complete or nearly complete in 11 patients (91.7%). Median distal resection and circumferential resection margins were 18.5 mm and 10 mm, respectively. Median number of harvested lymph nodes was 15. Median length of hospital stay was 9 days. There were no postoperative deaths. Six patients experienced minor postoperative complications, including urinary dysfunction in 2, transient ileus in 3, and wound abscess in 1.
CONCLUSION
This pilot study showed that high-quality TME was possible in most patients without serious complications. Transanal TME for patients with rectal cancer may be feasible and safe, but further investigations are necessary to evaluate its long-term functional and oncologic outcomes and to clarify its indications.

Keyword

Natural orifice endoscopic surgery; Minimally invasive surgical procedures; Rectal neoplasms; Transanal endoscopic surgery

MeSH Terms

Abscess
Body Mass Index
Chemoradiotherapy
Female
Humans
Ileus
Intraoperative Complications
Laparoscopy
Length of Stay
Lymph Nodes
Male
Minimally Invasive Surgical Procedures
Natural Orifice Endoscopic Surgery
Pilot Projects*
Postoperative Complications
Rectal Neoplasms*
Transanal Endoscopic Surgery
Wounds and Injuries

Figure

• 

  Fig. 1 Illustration of the procedure. (A) An Octoport (Dalim, Seoul, Korea) was placed on the potential ileostomy site of the right iliac fossa. (B) A GelPOINT path (Applied Medical Inc., Rancho Santa Margarita, CA, USA) was installed at the anus after purse string suturing and full-thickness circumferential transection of the distal part of the tumor.

• 

  Fig. 2 Grading of surgical specimens. (A) The specimen removed from patient No. 1 was graded as 'complete' total mesorectal excision (TME) according to the Quirke method. (B) Due to the quality of the mesorectum, the specimen removed from patient No. 2 was graded as 'incomplete' TME.

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