Introduction Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short‐term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results Of 2579 included patients, 76.2% (1966/2579) underwent TME with restorative anastomosis of which 19.9% (312/1966) had a minimally invasive approach (laparoscopic or robotic) which included a transanal component (TaTME). Overall, 9.0% (175/1951, 15 missing outcome data) of patients suffered an anastomotic leak. On univariate analysis both laparoscopic TaTME (OR 1.61, 1.02–2.48, P = 0.04) and robotic TaTME (OR 3.05, 1.10–7.34, P = 0.02) were associated with a higher risk of anastomotic leak than non‐transanal laparoscopic TME. However this association was lost in the mixed‐effects model controlling for patient and disease factors (OR 1.23, 0.77–1.97, P = 0.39 and OR 2.11, 0.79–5.62, P = 0.14 respectively), whilst low rectal anastomosis (OR 2.72, 1.55–4.77, P < 0.001) and male gender (OR 2.29, 1.52–3.44, P < 0.001) remained strongly associated. The overall positive circumferential margin resection rate was 4.0%, which varied between operative approaches: laparoscopic 3.2%, transanal 3.8%, open 4.7%, robotic 1%. Conclusion This contemporaneous international snapshot shows that uptake of the TaTME approach is widespread and is associated with surgically and pathologically acceptable results.
Background: Currently, cancer is one of the main causes of mortality worldwide. In Peru, gastric cancer is one of the most aggressive and frequent entities, with a higher mortality rate in the highlands. Eight out of 10 cases of gastric cancer are detected in advanced stages. Therefore, we looked for detection of early gastric cancer or possible precancerous lesions with the use of a new technology. Gastric intestinal metaplasia (IM) and Gastric Atrophy (GA) are considered precancerous lesions for gastric cancer. Using conventional endoscopy, IM or GAn be very difficult to identify, furthermore random biopsies could lead to sampling errors. A systematic endoscopic approach helps to have a full evaluation of the gastric surface. Blue Laser Imaging Magnification chromoendoscopy (M-BLI) allows optical interrogation of microvasculature and microsurface of abnormal areas, being able to target biopsies appropriately. Methods: This is a retrospective study of upper endoscopies performed using EG-L590ZW Lasereo (Fujifilm Co., Tokyo, Japan) from April 2016 to April 2017 in symptomatic patients. We determined prevalence of IM using a systematic endoscopy approach with at least 28 pictures. We also determined sensitivity, specificity, positive predictive value, negative predictive value and kappa index of M-BLI compared to histopathological findings of targeted and Sydney protocol biopsies. Results: A total of 300 patients were included, average age was 53 y.o (range 23-87), 60.3% females. IM and GA prevalence were 20.7% and 1%, respectively. 93.7% of the patients presented superficial chronic gastritis and 11.3% patients were positive for H. pylori. The sensitivity, specificity, positive predictive value, negative predictive value and kappa index of IM determined by M-BLI were 79%, 91%, 69%, 94% and 0.66. There was no concordance of GA determined by M-BLI. We did not find a statistically significant relationship between IM and age, sex or prevalence of Hp. Conclusions: A systematic endoscopy approach combined with M-BLI allows an accurate detection and prediction of IM. This might help early gastric detection on follow up. Further studies should be done testing this promising technology and endoscopic systematic approach.
Introduction The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre‐operative imaging. Methods A pre‐planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post‐treatment MRI restaging (yMRI) and final pathological staging. Results Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post‐treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T‐stage, N‐stage, or AJCC status were each graded as ‘fair’ only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion The reported pCR rate of 10% highlights the potential for non‐operative management in selected cases. The limited strength of agreement between basic conventional post‐chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.
Background Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. Methods Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30‐day major complication rate, defined as Clavien‐Dindo grade III‐V. Results Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27–2.11, P < 0.001). Conclusions Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection.
Background and aims: Occurrence of metastasis to the gastrointestinal tract (GIT) is rare. The studies on the endoscopic findings of metastatic tumors are usually restricted to small case series. As a consequence of the improved in the survival time for cancer patients over recent years, it is expected that progressively more cancer patients could present for diagnosis, by endoscopy, of secondary tumors of the GIT. With this regard, it would be useful to better characterize the endoscopic aspects of metastases to the GIT. Methods: observational study conducted in an oncological referral center between January 2009 and August 2017. The study included patients with metastasis to the GIT, submitted to endoscopic exam (upper gastrointestinal endoscopy, colonoscopy, enteroscopy, endoscopic ultrasound) with histological confirmation. Patients with lymphoma, leukemia, multiple myeloma, Kaposi sarcoma or direct invasion from adjacent organs were excluded. Results: From January 2009 to august 2017, 53.675 endoscopic exams were performed. A total of 184 cases were suspected gastrointestinal metastasis. In 94 patients the diagnosis was confirmed. The baseline characteristics of the patients are summarized in Table 1. Common indications for endoscopy were abdominal pain (29 cases -30.8%), gastrointestinal bleeding (28 cases -29.8%) and vomiting (18 cases -19.1%). The most common site of metastasis was the stomach (60 cases -59.6%), followed by small bowel (29 cases -29.8%) and colon (7 cases -7.4%). Eight patients (8.5%) had metastasis in more than one site in the GIT. As indicated in Table 2, the most common primary malignancy was melanoma (25 cases -26.6%), followed by breast (14 cases -14.9%) and lung (14 cases -14.9%). If considered just the gastric metastasis, the most common primary malignancy was melanoma (17 cases -28.3%), breast (11 cases -18.3 %) and lung (7 -11.3%). The most common endoscopic presentation of the metastatic lesions in the stomach was a solitary (32 cases -53.3 %), ulcerated (31 cases -51.6%) lesion located in the gastric body (75%). If considered just the small bowel metastasis the most common primary malignancy was lung (7 cases -24.1%) and melanoma (7 cases -24.1%) followed by breast (3 cases -10.4%). The most common endoscopic presentation of the metastatic lesions in small bowel was the presence of a solitary (22 cases 84.6 %), polypoid (10 cases -38.5%) lesion located in the second portion of duodenum (17 cases -65.4%). Conclusions: Melanoma, breast and lung cancer were the most common metastasis to the GIT. The stomach was the main site of the metastatic lesions and the most common endoscopic presentation of stomach metastasis was solitary, ulcerated lesions in the gastric body. Despite the rarity of this condition, endoscopists should be aware of this differential diagnosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.