Background:Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision(h-taTME),a completely incisionless surgical procedure has not ye...Background:Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision(h-taTME),a completely incisionless surgical procedure has not yet been developed.This study was performed to explore the efficacy of pure taTME(p-taTME)without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer.Methods:We retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018.Relevant patient characteristics and clinical information including the surgical procedure,specimens,pathological characteristics,and patients’post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed.Results:Fifty-five patients who had undergone p-taTME were included in this study.They comprised 32(58.2%)men and 23(41.8%)women with a mean age of 65.6610.6 years and mean body mass index of 23.463.3 kg/m^(2).The median surgical time was 180.0(range,130–360)min and estimated blood loss was 25.0(range,15–80)mL.The commonest post-operative complication was varying degrees of faecal incontinence(56.4%).However,such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients’quality of life.Conclusions:p-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer,especially in those with obesity or a narrow pelvis.However,further studies of the indications and long-termefficacy are needed to verify the suitability of this procedure.展开更多
Background:Although the clinical importance of complete,intact total mesorectal excision(TME)is the widely accepted standard for decreasing local recurrence of rectal cancer,the residual mesorectum still represents a ...Background:Although the clinical importance of complete,intact total mesorectal excision(TME)is the widely accepted standard for decreasing local recurrence of rectal cancer,the residual mesorectum still represents a significant component of resection margin involvement.This study aimed to use a visible intraoperative sign to detect the distal mesorectal end to ensure complete inclusion of the mesorectum and avoid unnecessary over-dissection.Methods:The distal mesorectum end was investigated retrospectively through a review of 124 operative videos at the Union Hospital of Fujian Medical University(Fujian,China)and Cleveland Clinic(Ohio,USA)by two independent surgeons who were blinded to each other.Furthermore,28 cadavers and 44 post-operative specimens were prospectively examined by hematoxylin and eosin(H&E)staining and Masson’s staining to validate and confirm the findings of the retrospective part.Univariate and multivariate analyses were carried out to detect the independent factors that can affect the visualization of the distal mesorectal end.Results:The terminal line(TL)is the distal mesorectal end of the transabdominal and transanal TME(taTME)and appears as a remarkable pearly white fascial structure extending posteriorly from 2 to 10 o’clock.Histopathological examination revealed that the fascia propria of the rectum merges with the presacral fascia at the TL,beyond which the mesorectum ends,with no further downward extension.In the retrospective observation,the TL was seen in 56.6%of transabdominal TME and 56.0%of taTME operations.Surgical approach and tumor distance from the anal verge were the independent variables that directly influenced the detection of the TL(P=0.03 and P=0.01).Conclusion: The TL is a visible sign where the transabdominal TME should end and the taTME should begin. Recognitionof the mesorectal end may impact the certainty of complete mesorectum inclusion. Further clinical trials are needed toconfirm the preliminary findings.展开更多
In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and ...In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.展开更多
文摘Background:Although the anatomic difficulties of laparoscopic surgery for rectal cancer have been resolved by hybrid transanal total mesorectal excision(h-taTME),a completely incisionless surgical procedure has not yet been developed.This study was performed to explore the efficacy of pure taTME(p-taTME)without laparoscopic assistance as a completely non-invasive surgical procedure for rectal cancer.Methods:We retrospectively evaluated all patients with rectal cancer who underwent p-taTME between December 2015 and April 2018.Relevant patient characteristics and clinical information including the surgical procedure,specimens,pathological characteristics,and patients’post-operative state were analysed and the feasibility of p-taTME in patients with rectal cancer was assessed.Results:Fifty-five patients who had undergone p-taTME were included in this study.They comprised 32(58.2%)men and 23(41.8%)women with a mean age of 65.6610.6 years and mean body mass index of 23.463.3 kg/m^(2).The median surgical time was 180.0(range,130–360)min and estimated blood loss was 25.0(range,15–80)mL.The commonest post-operative complication was varying degrees of faecal incontinence(56.4%).However,such incontinence greatly improved after pelvic-floor-function-rehabilitation exercises and did not seriously affect the patients’quality of life.Conclusions:p-taTME is a relatively safe and incisionless procedure for patients with middle and low rectal cancer,especially in those with obesity or a narrow pelvis.However,further studies of the indications and long-termefficacy are needed to verify the suitability of this procedure.
基金supported by the Chinese Scholarship Council(CSC)[grant number 2017DFH010880].
文摘Background:Although the clinical importance of complete,intact total mesorectal excision(TME)is the widely accepted standard for decreasing local recurrence of rectal cancer,the residual mesorectum still represents a significant component of resection margin involvement.This study aimed to use a visible intraoperative sign to detect the distal mesorectal end to ensure complete inclusion of the mesorectum and avoid unnecessary over-dissection.Methods:The distal mesorectum end was investigated retrospectively through a review of 124 operative videos at the Union Hospital of Fujian Medical University(Fujian,China)and Cleveland Clinic(Ohio,USA)by two independent surgeons who were blinded to each other.Furthermore,28 cadavers and 44 post-operative specimens were prospectively examined by hematoxylin and eosin(H&E)staining and Masson’s staining to validate and confirm the findings of the retrospective part.Univariate and multivariate analyses were carried out to detect the independent factors that can affect the visualization of the distal mesorectal end.Results:The terminal line(TL)is the distal mesorectal end of the transabdominal and transanal TME(taTME)and appears as a remarkable pearly white fascial structure extending posteriorly from 2 to 10 o’clock.Histopathological examination revealed that the fascia propria of the rectum merges with the presacral fascia at the TL,beyond which the mesorectum ends,with no further downward extension.In the retrospective observation,the TL was seen in 56.6%of transabdominal TME and 56.0%of taTME operations.Surgical approach and tumor distance from the anal verge were the independent variables that directly influenced the detection of the TL(P=0.03 and P=0.01).Conclusion: The TL is a visible sign where the transabdominal TME should end and the taTME should begin. Recognitionof the mesorectal end may impact the certainty of complete mesorectum inclusion. Further clinical trials are needed toconfirm the preliminary findings.
文摘In recent years,natural orifice specimen extraction surgery(NOSES)in the treatment of colorectal cancer has attracted widespread attention.The potential benefits of NOSES including reduction in postoperative pain and wound complications,less use of postoperative analgesic,faster recovery of bowel function,shorter length of hospital stay,better cosmetic and psychological effect have been described in colorectal surgery.Despite significant decrease in surgical trauma of NOSES have been observed,the potential pitfalls of this technique have been demonstrated.Particularly,several issues including bacteriological concerns,oncological outcomes and patient selection are raised with this new technique.Therefore,it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery.After three rounds of discussion by all members of the International Alliance of NOSES,the consensus is finally completed,which is also of great significance to the long-term progress of NOSES worldwide.
