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Short-term outcomes of laparoscopic-assisted transanal vs laparoscopic total mesorectal excision for mid-to-low rectal cancer 认领 引用
1
作者 Qi Huang Yue Li +4 位作者 Shi-Dong Feng Yu-Chen Fang Yuan-Hang Zhou Da-Wei Li Zhi-Wei Liao 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第1期162-173,共12页
BACKGROUND Traditional laparoscopic total mesorectal excision(LaTME)presents challenges in patients with low rectal cancer,including difficult surgical exposure and positive margin risks.AIM To compare the short-term ... BACKGROUND Traditional laparoscopic total mesorectal excision(LaTME)presents challenges in patients with low rectal cancer,including difficult surgical exposure and positive margin risks.AIM To compare the short-term outcomes of laparoscopic-assisted transanal total mesorectal excision(TaTME)and LaTME for mid-to-low rectal cancer.METHODS A retrospective analysis of 138 patients with rectal cancer was conducted,and they were divided into the TaTME group(n=66)and the LaTME group(n=72).Surgical indicators,pathological outcomes,recovery parameters,inflammatory markers,and anal function were compared.RESULTS The two groups showed comparable baseline characteristics(P>0.05).The TaTME group demonstrated superior intraoperative performance with significantly less blood loss(78.4±28.6 mL vs 118.7±35.2 mL,P<0.001),reduced hemoglobin decrease(18.3±8.7 g/L vs 26.8±12.4 g/L,P=0.002),and lower vasoactive drug requirement(6.1%vs 15.3%,P=0.044).Pathologically,TaTME achieved better oncological outcomes including lower circumferential resection margin-positive rate(4.5%vs 13.9%,P=0.032),higher lymph node harvest(17.8±4.6 vs 15.2±4.1,P=0.001),and improved complete total mesorectal excision rate(89.4%vs 77.8%,P=0.048).The TaTME group exhibited accelerated gastrointestinal recovery with shorter times to first flatus(2.1±0.8 days vs 2.8±1.2 days,P=0.001)and reduced hospital stay(7.8±2.1 days vs 9.4±2.8 days,P=0.001).Inflammatory markers were significantly lower,including postoperative day 2 interleukin(IL)-6(42.6±12.8 pg/mL vs 56.3±15.7 pg/mL,P<0.001)and C-reactive protein peaks(68.4±18.2 mg/L vs 89.7±24.6 mg/L,P<0.001).Multivariate analysis revealed TaTME as an independent protective factor for good anal function(odds ratio=0.234,P=0.003),while tumor distance≤2 cm,elevated IL-6,and neoadjuvant therapy were risk factors.These findings demonstrate TaTME's advantages in surgical safety,oncological quality,postoperative recovery,and functional preservation.CONCLUSION TaTME demonstrates superior short-term outcomes in surgical safety,oncological quality,and functional recovery to LaTME,warranting clinical promotion. 展开更多
关键词 Rectal cancer Laparoscopic-assisted transanal total mesorectal excision Laparoscopic total mesorectal excision Low rectal cancer Oncological outcomes Postoperative recovery
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Sutured rectal lift for obstructed defecation:Mesh-free sphincterpreserving transanal technique for Oxford gradeⅡ-Ⅲprolapse 认领 引用
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作者 Claudio Eduardo Pagano Sonia Sarnari +4 位作者 Umberto Favetta Roberto Picheo Fabrizio Gambarini Angelo Guttadauro Michele Schiano di Visconte 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第3期305-314,共10页
BACKGROUND Obstructed defecation syndrome(ODS)frequently results from an internal rectal prolapse,which disrupts the rectal axis and impairs evacuation.Resectional transanal operations can remove redundant tissue,but ... BACKGROUND Obstructed defecation syndrome(ODS)frequently results from an internal rectal prolapse,which disrupts the rectal axis and impairs evacuation.Resectional transanal operations can remove redundant tissue,but fail to restore structural support,whereas abdominal mesh rectopexy involves prosthetic materials and has a higher operative burden.The sutured rectal lift(SuReL)was developed as a reconstructive,non-resective,and mesh-free transanal technique to restore rectal suspension while preserving continence in patients with ODS secondary to internal prolapse.AIM To describe the rationale,indications,and step-by-step operative technique of SuReL for Oxford gradeⅡ-Ⅲinternal rectal prolapse causing obstructed defecation.METHODS SuReL was performed using the Sylarum®transanal access device.The rectal wall was addressed sequentially in six circumferential sectors(11,1,9,3,7,and 5 o’clock).In each sector,a triphasic suture sequence with a barbed 0/0 monofilament(Filbloc®)was placed:(1)A mucosa-submucosa pass;(2)A deeper pass including the muscularis layer at the same level;and(3)A third pass 3 mm caudally,forming a semiloop for suspension.Cranial plications advanced distally to the upper limit of the prolapse.A deep circumferential reinforcement layer with a 2/0 Assuplus®monofilament consolidated the lift.RESULTS The procedure standardizes the reconstructive phase through sector-based rotation,allowing symmetric traction and full-thickness suspension without resection.Operative pearls consist of maintaining uniform exposure,ensuring precise semiloop depth for tension control,and verifying lumen patency with saline irrigation.Key technical advantages include the absence of stapling devices or prosthetic materials,minimal bleeding,a short operative time,and preservation of mucosal sensitivity.Postoperative recovery is typically rapid with early mobilization and minimal discomfort.CONCLUSION SuReL represents a technically reproducible and standardized approach for the treatment of internal rectal prolapse.This preclinical study demonstrated feasibility and mechanical consistency using anatomical simulators,while the clinical efficacy and physiological benefits remain to be validated in prospective trials. 展开更多
关键词 Obstructed defecation syndrome Internal rectal prolapse Transanal surgery Sphincter preservation Rectal suspension Surgical standardization
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Beyond stapled transanal rectal resection vs ventral rectopexy dichotomy:Toward a phenotype-guided surgical paradigm for obstructed defecation syndrome 认领 引用
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作者 Michele Schiano di Visconte Sonia Sarnari 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第2期25-35,共11页
Obstructed defecation syndrome(ODS)is a heterogeneous pelvic floor disorder in which a persistent focus on“stapled transanal rectal resection(STARR)vs ventral rectopexy(VR)”has encouraged procedure-driven rather tha... Obstructed defecation syndrome(ODS)is a heterogeneous pelvic floor disorder in which a persistent focus on“stapled transanal rectal resection(STARR)vs ventral rectopexy(VR)”has encouraged procedure-driven rather than phenotype-guided care.This opinion review synthesizes contemporary evidence on STARR and VR and proposes a phenotype-guided algorithm for surgical decision-making in ODS.We first summarize comparative outcome data,highlighting higher rates of late recurrence and urgency after STARR in contrast to more durable functional relief but greater invasiveness and mesh-related concerns after VR.We then outline a structured preoperative workup that integrates symptom scores,fluoroscopic or magnetic resonance defecography,and high-resolution anorectal manometry to discriminate between isolated structural disease,complex multilevel prolapse,functional defecatory disorders,mixed phenotypes,and ODS with impaired continence or excessive perineal descent.For each phenotype,we discuss the optimal role of STARR,VR,perineal resections,pelvic organ prolapse suspension,neuromodulation,and transverse perineal support within staged,multimodal pathways.Finally,we identified research priorities,including stratified randomized trials and phenotype-indexed multicenter registries,to validate this algorithm and refine the indications.Reframing ODS management around phenotyping,rather than procedural dichotomies,may improve patient selection,reduce functional failure,and align pelvic floor surgery with a broader movement toward precision medicine. 展开更多
关键词 Obstructed defecation syndrome Stapled transanal rectal resection Ventral rectopexy Phenotype-guided surgery Pelvic floor disorders Multidisciplinary management Functional constipation Patient stratification
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Carbon dioxide embolism during salvage transanal total mesorectal excision in“frozen pelvis”:Two case reports 认领 引用
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作者 Cai-Ping Li Yi-Ming Lv 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第7期361-367,共7页
BACKGROUND Transanal total mesorectal excision(TaTME)is increasingly used for salvage surgery in local rectal cancer recurrence.However,the fibrotic“frozen pelvis”presents a unique physiological hazard.We report two... BACKGROUND Transanal total mesorectal excision(TaTME)is increasingly used for salvage surgery in local rectal cancer recurrence.However,the fibrotic“frozen pelvis”presents a unique physiological hazard.We report two cases of massive carbon dioxide(CO2)embolism that occurred during salvage TaTME,highlighting the mechanism of“non-collapsible veins”and a specific capnographic diagnostic pattern.CASE SUMMARY Two male patients(64 years old and 68 years old,respectively)underwent salvage TaTME for recurrent rectal cancer.Both procedures utilized a simultaneous twoteam approach with standard 15 mmHg insufflation.During deep pelvic dissection within the fibrotic field,both patients experienced sudden hemodynamic collapse(severe hypotension in case 1 and asystole in case 2).A distinct biphasic capnographic pattern was observed in both scenarios:An initial precipitous drop in end-tidal CO2 marking the embolic event,followed by a rapid paradoxical surge(>50 mmHg)during resuscitation.This“rebound hypercapnia”confirmed the massive systemic CO2 absorption.Immediate cessation of insufflation,fluid resuscitation,and conversion to open surgery were performed.One patient recovered without sequelae,while the other patient achieved return of spontaneous circulation after cardiopulmonary resuscitation.CONCLUSION Enhanced vigilance for CO2 embolism is strongly advised in the“frozen pelvis”.The biphasic capnographic signature can serve as a critical observational point for early recognition,and a rapid multidisciplinary response involving the nursing team is essential for patient survival. 展开更多
关键词 Carbon dioxide embolism Transanal total mesorectal excision Frozen pelvis Salvage surgery Perioperative nursing Case report
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Comparative efficacy analysis of laparoscopic-assisted transanal total mesorectal excision vs laparoscopic transanal mesorectal excision for low-lying rectal cancer 认领 引用 被引量：3
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作者 Feng Lu Shu-Guang Tan +3 位作者 Juan Zuo Hai-Hua Jiang Jian-Hua Wang Yu-Ping Jiang 《World Journal of Gastrointestinal Surgery》 SCIE 2025年第1期147-155,共9页
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be... BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC. 展开更多
关键词 Laparoscopic total mesorectal excision Transanal total mesorectal excision Low-lying rectal cancer Quality of life Stress response
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Comparison of endoscopic submucosal dissection and transanal endoscopic microsurgery for stage 1 rectal neuroendocrine tumors 认领 引用 被引量：1
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作者 Jun Weng Jun Chi +4 位作者 Yan-Hua Lv Ruo-Bing Chen Guo-Liang Xu Xian-Feng Xia Kun-Hao Bai 《World Journal of Gastrointestinal Endoscopy》 2025年第2期7-15,共9页
BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o... BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM. 展开更多
关键词 Rectal neuroendocrine tumors Endoscopic submucosal dissection Transanal endoscopic microsurgery Safety Efficacy
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Endoscopic submucosal dissection, transanal endoscopic microsurgical submucosal dissection, and transanal minimally invasive surgery in rectal lesions 认领 引用
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作者 Enver Ilhan Fevzi Cengiz 《World Journal of Gastrointestinal Endoscopy》 2025年第10期57-65,共9页
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc... The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors. 展开更多
关键词 Endoscopic submucosal dissection Transanal endoscopic microsurgical submucosal dissection Transanal minimally invasive surgery Rectal adenomas Early rectal cancer Minimally invasive colorectal surgery En bloc resection Local excision techniques
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Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience 认领 引用 被引量：10
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作者 Wei-Cheng Liu Song-Lin Wan +7 位作者 SM Yaseen Xiang-Hai Ren Cui-Ping Tian Zhao Ding Ken-Yan Zheng Yun-Hua Wu Cong-Qing Jiang Qun Qian 《World Journal of Gastroenterology》 SCIE CAS 2016年第35期7983-7998,共16页
Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychologica... Obstructed defecation syndrome(ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors' center is also presented. 展开更多
关键词 Obstructive defecation syndrome Transanal surgery Transanal manual technique Transanal stapling procedure Medical assessment Clinical outcome Clinical experience
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Transanal intersphincteric approach combined with Kangfuxin enema for treating anastomotic leakage after low anterior resection: Three case reports 认领 引用
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作者 Hui Li Hai-Bin Huang +4 位作者 Tao Xiang Lu Yang Edgar J B Furnée Ge Sun Wen-Bin Chen 《World Journal of Gastrointestinal Surgery》 SCIE 2025年第10期419-427,共9页
BACKGROUND Anastomotic leakage(AL)is a serious and challenging complication following low anterior resection(LAR)for low rectal cancer.This case series presents the successful management of AL in three patients using ... BACKGROUND Anastomotic leakage(AL)is a serious and challenging complication following low anterior resection(LAR)for low rectal cancer.This case series presents the successful management of AL in three patients using a combined approach of transanal opening of the intersphincteric space(TROPIS)surgery and adjuvant Kangfuxin liquid enema therapy.CASE SUMMARY Three male patients underwent laparoscopic LAR with diverting ileostomy for low rectal cancer.Case 1:A 39-year-old,presented with fever and abdominal distension 2 weeks after discharge.A digital rectal examination revealed partial anastomotic separation.Case 2:A 74-year-old,developed abdominal pain and fever on postoperative day 5,with fecal discharge through the pelvic drain,and computed tomography scan confirmed AL.Case 3:A 51-year-old,was asymptomatic but diagnosed with AL 1 week after discharge;despite 1 year of conservative management,the leakage failed to heal.All three patients were subsequently treated with TROPIS surgery combined with twice-daily Kangfuxin liquid enemas,resulting in complete resolution of AL in each case.CONCLUSION The combination of TROPIS and Kangfuxin enema appears to be a safe and effective approach for managing AL following LAR.This minimally invasive strategy offers a promising alternative to conventional surgical interventions.Further studies with larger cohorts are warranted to validate these findings. 展开更多
关键词 Low rectal cancer Anastomotic leakage Transanal opening of the intersphincteric space Kangfuxin liquid Enema therapy Case report
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Complete resection of recurrent anal canal cancer using endoscopic submucosal dissection and transanal resection: A case report 认领 引用
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作者 Mayuko Kinoshita Tetsuro Maruyama +7 位作者 Shutaro Hike Takuya Hirosuna Shunsuke Kainuma Kazuya Kinoshita Akira Nakano Gaku Ohira Masaya Uesato Hisahiro Matsubara 《World Journal of Gastrointestinal Endoscopy》 2025年第1期54-60,共7页
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a... BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately. 展开更多
关键词 Anal canal cancer Recurrence Endoscopic submucosal dissection Transanal resection Case report
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Is the use of a transanal drainage tube effective in treating anastomotic leakage for mid-low rectal cancer 认领 引用
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作者 Yu-Kun Cao Shi-Lai Yang Zheng-Qiang Wei 《World Journal of Clinical Oncology》 2025年第4期102-108,共7页
BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS ... BACKGROUND Anastomotic leakage(AL)is a severe surgical complication for mid-low rectal cancers.The efficacy of transanal drainage tube(TDT)has rarely been reported.AIM To evaluate the efficacy of TDT after AL.METHODS A retrospective analysis was conducted on 68 patients with mid-low rectal cancer who underwent laparoscopic low anterior resection(LAR)and developed ALs.Leakage were identified using imaging studies and digital rectal examinations when local abscesses or systemic infections were present.In each patient,the leakage site was determined using the index finger and a drainage tube was inserted transanally to drain the abscesses and exudates outside the anus.The clinical outcomes of the patients following transanal drainage were analyzed.RESULTS A total of 43 patients received TDT treatment,while 25 patients did not receive TDT treatment.Among the patients in the TDT group,9 required reoperation compared to 12 in the non-TDT group.In the TDT group,76.74%of the patients were able to restore intestinal continuity,whereas only 40%of the patients in the non-TDT group achieved restored intestinal continuity.In the TDT group,48.48%of patients developed LAR syndrome(LARS),whereas in the non-TDT group,90%of patients developed LARS.The median drainage time was 7 days,the median postoperative hospital stay was 21 days,the median fasting time was 6.5 days,and the median hospitalization cost was 109205.93 RMB.CONCLUSION TDT use lowered reoperation rate but did not increase hospitalization expenses.After≥1 year of follow-up,its use improved intestinal patency rate and reduced the incidence of LARS. 展开更多
关键词 Rectal cancer Anastomotic leakage Transanal drainage tube Low anterior resection syndrome Therapy
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Transanal endoscopic surgery in rectal cancer 认领 引用 被引量：14
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作者 Xavier Serra-Aracil Laura Mora-Lopez +3 位作者 Manel Alcantara-Moral Aleidis Caro-Tarrago Carlos Javier Gomez-Diaz Salvador Navarro-Soto 《World Journal of Gastroenterology》 SCIE CAS 2014年第33期11538-11545,共8页
Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TE... Total mesorectal excision(TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery(TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond(T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentageof infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present. 展开更多
关键词 Rectal cancer Rectal adenocarcinoma Transanal endoscopic microsurgery Transanal endo-scopic surgery Colorectal cancer
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Transanal eco-Doppler evaluation after hemorrhoidal artery embolization 认领 引用 被引量：2
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作者 Roberta Tutino Tommaso Stecca +2 位作者 Fabrizio Farneti Marco Massani Giulio Aniello Santoro 《World Journal of Gastroenterology》 SCIE CAS 2024年第17期2332-2342,共11页
BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and... BACKGROUND Hemorrhoidal artery embolization(Emborrhoid)is a novel method for the treatment of severe hemorrhoidal bleeding.Despite having a technical success rate of 93%-100%,the clinical success ranges between 63%and 94%,with a rebleeding rate of 13.6%.AIM To evaluate the effectiveness of this procedure in reducing hemorrhoidal flow and hemorrhoidal bleeding.METHODS This prospective observational pilot study was conducted at Division of General Surgery 1 and Tertiary Referral Pelvic Floor Center,Treviso Regional Hospital,Italy.In a 2 months period(February-March 2022),consecutive patients with hemorrhoidal bleeding scores(HBSs)≥4,Goligher scores of II or III,failure of non-operative management,and a candidate for Emborrhoid were included.Endoanal ultrasound with eco-Doppler was performed preoperatively and 1 month after the procedure.The primary endpoint was to quantify the changes in arterial hemorrhoidal flow after treatment.The secondary endpoint was to evaluate the correlation between the flow changes and the HBS.RESULTS Eleven patients underwent Emborrhoid.The overall pretreatment mean systolic peak(MSP)was 14.66 cm/s.The highest MSP values were found in the anterior left lateral(17.82 cm/s at 1 o’clock and 15.88 cm/s at 3 o’clock)and in the posterior right lateral(14.62 cm/s at 7 o’clock and 16.71 cm/s at 9 o’clock)quadrants of the anal canal.After treatment,the overall MSP values were significantly reduced(P=0.008)although the correlation between MSP and HBS changes was weak(P=0.570).A statistical difference was found between distal embolization compared with proximal embolization(P=0.047).However,the coil landing zone was not related to symptoms improvement(P=1.000).A significant difference in MSP changes was also reported between patients with type 1 and type 2 superior rectal artery(SRA)anatomy(P=0.040).No relationship between hemorrhoidal grades(P=1.000),SRA anatomy(P=1.000)and treatment outcomes was found.CONCLUSION The preliminary findings of this pilot study confirm that Emborrhoid was effective in reducing the arterial hemorrhoidal flow in hemorrhoidal disease.However,the correlation between the post-operative MSP and HBS changes was weak.Hemorrhoidal grade,SRA anatomy and type of embolization were not related to treatment outcomes. 展开更多
关键词 Hemorrhoidal artery embolization Hemorrhoidal embolization Hemorrhoidal vascularization Transanal eco-Doppler Transanal ultrasound
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Transanal minimally invasive surgery using laparoscopic instruments of the rectum:A review 认领 引用 被引量：4
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作者 Myung Jo Kim Taek-Gu Lee 《World Journal of Gastrointestinal Surgery》 SCIE 2021年第10期1149-1165,共17页
Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of beni... Transanal minimally invasive surgery(TAMIS)was first described in 2010 as an alternative to transanal endoscopic microsurgery(TEM).The TAMIS technique can be access to the proximal and mid-rectum for resection of benign and earlystage malignant rectal lesions and also used for noncurative intent surgery of more advanced lesions in patients who are not candidates for radical surgery.TAMIS has a shorter learning curve,reduced device setup time,flexibility in instrument use,and versatility in application than TEM.Also,TAMIS shows similar results in a view of the operation time,conversion rate,reoperation rate,and complication to TEM.For these reasons,TAMIS is an easily accessible,technically feasible,and cost-effective alternative to TEM.Overall,TAMIS has enabled the performance of high-quality local excision of rectal lesions by many colorectal surgeons.As TAMIS becomes more broadly utilized such as pelvic abscess drainage,rectal stenosis,and treatment of anastomotic dehiscence,the acquisition of appropriate training must be ensured,and the continued assessment and assurance of outcome must be maintained. 展开更多
关键词 Transanal minimally invasive Rectal cancer Laparoscopic transanal excision Endoscopic resection Minimally invasive surgery Transanal endoscopic microsurgery
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Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors 认领 引用 被引量：16
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作者 Wei-Jie Chen Nan Wu +2 位作者 Jiao-Lin Zhou Guo-Le Lin Hui-Zhong Qiu 《World Journal of Gastroenterology》 SCIE CAS 2015年第30期9142-9149,共8页
AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patie... AIM:To assess the efficacy of full-thickness excision using transanal endoscopic microsurgery(TEM) in the treatment of rectal neuroendocrine tumors.METHODS:We analyzed the data of all rectal neuroendocrine tumor patients who underwent local full-thickness excision using TEM between December 2006 and December 2014 at our department. Data collected included patient demographics,tumor characteristics,operative details,postoperative outcomes,pathologic findings,and follow-ups. RESULTS:Full-thickness excision using TEM was performed as a primary excision(n = 38) or as complete surgery after incomplete resection by endoscopic polypectomy(n = 21). The mean size of a primary tumor was 0.96 ± 0.21 cm,and the mean distance of the tumor from the anal verge was 8.4 ± 1.4 cm. The mean duration of the operation was 57.6 ± 13.7 min,and the mean blood loss was 13.5 ± 6.6 m L. No minor morbidities,transient fecal incontinence,or wound dehiscence was found. Histopathologically,all tumors showed typical histology without lymphatic or vessel infiltration,and both deep and lateral surgical margins were completely free of tumors. Among 21 cases of complete surgery after endoscopic polypectomy,9 were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. Norecurrence was noted during the median of 3 years' follow-up.CONCLUSION:Full-thickness excision using TEM could be a first surgical option for complete removal of upper small rectal neuroendocrine tumors. 展开更多
关键词 Transanal endoscopic microsurgery Rectalneuroendocrine tumor Full-thickness excision Primaryexcision Complete excision Retrospective study
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Stapled transanal rectal resection for obstructed defecation syndrome associated with rectocele and rectal intussusception 认领 引用 被引量：24
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作者 Zhang, Bin Ding, Jian-Hua +2 位作者 Yin, Shu-Hui Zhang, Meng Zhao, Ke 《World Journal of Gastroenterology》 SCIE CAS 2010年第20期2542-2548,共7页
AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with r... AIM:To evaluate the safety and efficacy of stapled transanal rectal resection(STARR),and to analyze the outcome of the patients 12-mo after the operation.METHODS:From May 2007 to October 2008,50 female patients with rectocele and/or rectal intussusception underwent STARR.The preoperative status,perioperative and postoperative complications at baseline,3,6 and 12-mo were assessed.Data were collected prospectively from standardized questionnaires for the assessment of constipation[constipation scoring system,Longo’s obstructed defecation syndrome(ODS)score system,symptom severity score],patient satisfaction (visual analogue scale),and quality of life(Patient Assessment of Constipation-Quality of Life Questionnaire).RESULTS:At a 12-mo follow-up,significant improvement in the constipation scoring system,ODS score system,symptom severity score,visual analog scale and quality of life(P<0.0001)was observed.The symptoms of constipation improved in 90%of patients at 12 mo after surgery.The self-reported definitive outcome was excellent in 15(30%)patients,fairly good in 8(16%),good in 22(44%),and poor in 5(10%).CONCLUSION:STARR can be performed safely without major morbidity.Moreover,the procedure seems to be effective for patients with obstructed defecation associated with symptomatic rectocele and rectal intussusception. 展开更多
关键词 Stapled transanal rectal resection Obstructed defecation syndrome Rectocele Rectal intussusception
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Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer 认领 引用 被引量：19
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作者 Fang-Hai Han Li-Xin Hua +2 位作者 Zhi Zhao Jian-Hai Wu Wen-Hua Zhan 《World Journal of Gastroenterology》 SCIE CAS 2013年第43期7751-7757,共7页
AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergo... AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classi?cations from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages. 展开更多
关键词 Transanal specimen extraction Natural orifice specimen extraction Laparoscopic anterior resection Low/ultra-low anastomosis Total mesorectal excision
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Evolution of transanal total mesorectal excision for rectal cancer:From top to bottom 认领 引用 被引量：23
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作者 Sameh Hany Emile F Borja de Lacy +4 位作者 Deborah Susan Keller Beatriz Martin-Perez Sadir Alrawi Antonio M Lacy Manish Chand 《World Journal of Gastrointestinal Surgery》 SCIE 2018年第3期28-39,共12页
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ... The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME. 展开更多
关键词 Rectal cancer Total mesorectal excision Transanal total mesorectal excision Transanal total mesorectal excision Sphincter sparing surgery Colorectal surgery
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Treatment of rectal cancer by transanal endoscopic microsurgery: Experience with 425 patients 认领 引用 被引量：12
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作者 Mario Guerrieri Rosaria Gesuita +3 位作者 Roberto Ghiselli Giovanni Lezoche Andrea Budassi Maddalena Baldarelli 《World Journal of Gastroenterology》 SCIE CAS 2014年第28期9556-9563,共8页
AIM: To describe our experience in treating rectal cancer by transanal endoscopic microsurgery (TEM), report morbidity and mortality and oncological outcome.
关键词 Rectal cancer Transanal endoscopic microsurgery Chemoradiotherapy Local excision Downstaging
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Safety and survival outcomes of transanal natural orifice specimen extraction using prolapsing technique for patients with middle-to low-rectal cancer 认领 引用 被引量：9
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作者 Zhao Lu Haipeng Chen +6 位作者 Mingguang Zhang Xu Guan Zhixun Zhao Zheng Jiang Zheng Liu Zhaoxu Zheng Xishan Wang 《Chinese Journal of Cancer Research》 SCIE CAS CSCD 2020年第5期654-664,共11页
Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approa... Objective:The transanal approach to specimen collection,combined with the prolapsing technique,is a wellestablished and minimally invasive surgery for treating rectal cancer.However,reports on outcomes for this approach are sparse.We compared short-and long-term outcomes of conventional laparoscopic surgery(CLS)vs.transanal natural orifice specimen extraction(NOSE)using the prolapsing technique for patients with middle-to low-rectal cancer.Methods:From January 2013 to December 2017,we enrolled consecutive patients with middle-to low-rectal cancer undergoing laparoscopic anterior resection.Totally,50 patients who underwent transanal NOSE using the prolapsing technique were matched with 50 patients who received CLS.Clinical parameters and survival outcomes between the two groups were compared.Results:Estimated blood loss(29.70±29.28 vs.52.80±45.09 mL,P=0.003),time to first flatus(2.50±0.79 vs.2.86±0.76,P=0.022),time to liquid diet(3.62±0.64 vs.4.20±0.76 d,P<0.001),and the need for analgesics(22%vs.48%,P=0.006)were significantly lower for the NOSE group compared to the CLS group.The incidences of overall complications and fecal incontinence were comparable in both groups.After a median follow-up of 44.52 months,the overall local recurrence rate(6%vs.5%,P=0.670),3-year disease-free survival(86.7%vs.88.0%,P=0.945)and 3-year overall survival(95.6%vs.96.0%,P=0.708),were not significantly different.Conclusions:For total laparoscopic rectal resection,transanal NOSE using the prolapsing technique is effective and safe,and associated with less trauma and pain,a faster recovery,and similar survival outcomes compared to CLS. 展开更多
关键词 Natural orifice specimen extraction transanal specimen extraction rectal cancer prolapsing technique survival
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