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Title: Beyond transanal total mesorectal excision: short-term outcomes of transanal total mesorectal excision in locally advanced rectal cancer requiring resection beyond total mesorectal excision.
Epworth Authors: Rajkomar, Amrish
Smart, Philip
McCormick, Jacob
Heriot, Alexander
Warrier, Satish
Other Authors: Larach, Jose
Keywords: Extended Resection
Rectal Cancer
Total Mesorectal Excision
Transanal TME
Locally Advanced Rectal Cancer
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Apr-2021
Publisher: Wiley
Citation: Apr 23(4) 823-33.
Abstract: Aim: The aim of this work was to define the role of transanal total mesorectal excision (taTME) in locally advanced rectal cancer (LARC) requiring resection beyond the mesorectal plane. Method: We performed a retrospective review of the outcomes of a case series of patients undergoing taTME for rectal cancer with mesorectal fascia or adjacent organ involvement. Results: Eleven patients (six men) underwent taTME for LARC requiring resection beyond total mesorectal excision (TME). All had a restorative procedure. The transabdominal approach was open in five and minimally invasive in six cases. All patients required the resection of at least one adjacent structure, including presacral fascia, internal iliac vessels, nerve roots, uterus, vagina or seminal vesicles. Four patients required a pelvic side-wall lymph node dissection and four had intraoperative radiotherapy. In all cases, the transanal approach was useful to disconnect the rectum distally, resect adjacent organs or control the R1 risk-point. Three patients had a complication of Clavien-Dindo grade III or above (one mechanical bowel obstruction, one pelvic collection and one urine sepsis). There were no anastomotic complications. Ten patients had an R0 resection. During a median follow-up of 11 (8.6-16) months there were no local recurrences, but two patients had distant metastases. During the study period, eight patients underwent closure of their stoma whilst the remaining three have had normal anastomotic assessments and will be closed in the future. Conclusion: This early series shows that implementation of taTME for resections beyond TME may be feasible and safe in a highly selected setting.
DOI: 10.1111/codi.15446
PubMed URL:
ISSN: 1463-1318
Journal Title: Colorectal Disease
Type: Journal Article
Affiliated Organisations: Division of Cancer Surgery, PeterMacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.
Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Surgery, Austin Health, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Case Series and Case Reports
Appears in Collections:Cancer Services
General Surgery and Gastroenterology

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