Authors: J H Marks G A Montenegro J F Salem M V Shields G J Marks
Publish Date: 2016/05/13
Volume: 20, Issue: 7, Pages: 467-473
Abstract
Natural orifice translumenal endoscopic surgery NOTES has always made more sense in the colorectal field where the target organ for entry houses the pathology To address the question whether an adequate total mesorectal excision TME for rectal cancer can be performed from a transanal bottomsup approach we performed a casematched studyStarting in 2009 transanal TME taTME surgery was selectively used for rectal cancer after neoadjuvant therapy and prospectively entered into a database Between March 2012 and February 2014 17 consecutive taTME rectal cancer patients were identified and casematched to multiport laparoscopic TME MP TME based on age body mass index uT stage radiation dose level in the rectum and procedure Perioperative outcomes morbidity mortality local recurrence completeness of TME and radial and distal margins were analyzed Statistically significant differences were identified using Student’s t testThere were 12 transanal abdominal transanal TATA/5 abdominoperineal resection procedures in each group Data regarding overall/taTME/MP TME are as follows positivecircumferential margin 29/0/59 p = 032 Distal margin 0/0/0 Complete or nearcomplete TME 971/100/941 p = 032 Incomplete TME 29/0/59 p = 032 Local recurrence 29/59/0 p = 032 There were no perioperative mortalities Morbidity in each group 264/235/294 p = 079 There were no differences in perioperative or postoperative outcomes except days to clear liquids 1/2 days p = 003 and largest incision length 13/26 cm p = 005We demonstrated no differences in perioperative/postoperative outcomes or pathologic TME outcomes of transanal or bottomsup TME compared to standard laparoscopic TME TaTME is a promising progressive approach to NOTES and deserves additional evaluation
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