Current Trends in the Management of Low Rectal Tumors: Transanal Total Mesorectal Excision

AbstractPurpose of ReviewThe access of the low rectum is a surgical challenge and, in case of cancer, the outcome of the patient depends on the quality of the surgery. The transanal total mesorectal excision (taTME) is a surgical technique with a combined abdominal and perineal approach. We review the literature for technical aspect of taTME as well as comparisons with other techniques.Recent FindingsComparison with laparoscopic total mesorectal excision and taTME was summarized in a meta-analysis which showed better oncological results with lower circumferential margin involvement and better completeness of the mesorectum.SummaryTaTME is a safe approach. All steps of the intervention are well described and should be followed as numerous pitfalls exist. When compared with laparoscopic or robotic TME, the taTME showed to be safe with similar oncological results. Patients known to be difficult, male, obese, with a narrow pelvis, should be considered for the taTME approach.
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research

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ConclusionsVery low energy diets result in a clinically significant reduction in mesorectal fat with a lesser change in total pelvic fat, suggesting that very low energy diets may be useful for preparation for pelvic surgery in the obese. The distance from S1 to the posterior rectum correlates well with mesorectal reduction, making this a valuable clinical tool when volumetric analysis is not possible.  This analysis is limited to the quantification of the effect of the diet and cannot comment on the safety of this approach before pelvic cancer surgery.
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
ConclusionsAll surgical techniques for rectal cancer dissection have a role and may be considered appropriate. Some techniques have advantages over others in certain clinical situations, and the best outcomes may be achieved by considering all options before applying an individualised approach to each clinical situation.
Source: Techniques in Coloproctology - Category: Surgery Source Type: research
AbstractBackgroundVenous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator.MethodsPatients who underwent colorectal cancer resection from 2012 to 2016 were iden...
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research
Conclusion LAS in visceral obesity patients with CRC was a safer and less invasive alternative than open surgery, with fewer complications within the first 30 days postoperatively.
Source: European Journal of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Original Articles: Gastroenterology Source Type: research
ConclusionsThis report investigates significant predictors of stoma outlet obstruction in laparoscopic rectal cancer surgery for the first time. In laparoscopic procedure, stoma outlet obstruction should be particularly considered in obese patients who have especially thick subcutaneous fat of the abdominal wall.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
Conclusions: Bariatric surgery appears to be capable of partially reversing the obesity-related epigenome. The identification of potential epigenetic biomarkers predictive for the success of bariatric surgery may open new doors to personalized therapy for severe obesity. Introduction Obesity is currently a huge healthcare problem, worldwide, and is a risk factor for several diseases such as type 2 diabetes (T2D), cardiovascular disease and cancer (1). As the prevalence of obesity reaches pandemic proportions, this metabolic disease is estimated to become the biggest cause of mortality in the near future (2). In fact,...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
CONCLUSIONS: We conclude that this technique is a feasible, safe and valid adjunct to the double staple technique whenever intraabdominal application of the linear staple is difficult or unsafe. KEY WORDS: Colorectal cancer, Laparoscopic anterior resection, Double, Low colorectal anastomosis, Stapling technique. PMID: 30862771 [PubMed - in process]
Source: Annali Italiani di Chirurgia - Category: Surgery Tags: Ann Ital Chir Source Type: research
Abstract INTRODUCTION: In the UK, colorectal cancer is the fourth most common cancer and the second most common cause of cancer death. Surgery is the primary modality of treatment, but it is not without complications. Post-operative complications have been linked to preoperative of weight loss and loss of lean tissue, and also to obesity. Given sex differences in body composition, an examination of body composition and post-operative complications may provide valuable information. Therefore, the aim was to examine the relationship between male/female body composition and post-operative complications in patients wi...
Source: Clinical Colorectal Cancer - Category: Cancer & Oncology Authors: Tags: Eur J Clin Nutr Source Type: research
CONCLUSIONS: Adopting these strategies can facilitate laparoscopic mesorectal excision in the obese patient and may reduce conversion to open.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Technical Notes Source Type: research
Abstract The aim of this study was to identify patients undergoing colorectal cancer (CRC) resection who might benefit specifically from either an open or laparoscopic approach. From the NSQIP database (2012-2013), patients who underwent laparoscopic colectomy (LC) or open colectomy (OC) for CRC were identified. The two groups were matched and compared in terms of any, medical, and surgical complications. A wide range of patient characteristics were collected and analyzed. Interaction analysis was performed in a multivariable regression model to identify risk factors that may make LC or OC more beneficial in certa...
Source: The American Surgeon - Category: Surgery Authors: Tags: Am Surg Source Type: research
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