Critical surgical errors by junior fellows and trainees in low rectal cancer surgery: How to overcome?(A cross-sectional study)

Elghamrini, Yasser; Hassan, Mohamed Ibrahim Abu; samee, Karim Sabry abdel; Khalil, Ayman

doi:10.1016/j.amsu.2021.01.078

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Several intraoperative complications have been described for uLAR and LAR during the transanal or perineal approach. A cross-sectional study regarding surgical errors by junior fellows and trainees in low rectal cancer surgery has recently been published, with exciting conclusions [ 90 ]; in this cohort, inadvertent injuries were made during preparation for the DST CAA by either forceful introduction of the circular stapler, inadequate pursestring sutures or incidental opening of the stapled anorectal stump. Senior consultants successfully managed all injuries by colonanal hand-sewn anastomosis, colon pull-through, or combined abdominal and perineal approach.…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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Despite innovative advancements, distally located rectal cancer remains a critical disease of challenging management. The crucial location of the tumor predisposes it to a circumferential resection margin (CRM) that tends to involve the anal sphincter complex and surrounding organs, with a high incidence of delayed anastomotic complications and the risk of the pelvic sidewall or rarely inguinal lymph node metastases. In this regard, colorectal surgeons should be aware of other issues beyond total mesorectal excision (TME) performance. For decades, the concept of extralevator abdominoperineal resection to avoid compromised CRM has been introduced. However, the complexity of deep pelvic dissection with poor visualization in low-lying rectal cancer has led to transanal TME. In contrast, neoadjuvant chemoradiotherapy (NCRT) has allowed for the execution of more sphincter-saving procedures without oncologic compromise. Significant tumor regression after NCRT and complete pathologic response also permit applying the watch-and-wait protocol in some cases, now with more solid evidence. This review article will introduce the current surgical treatment options, their indication and technical details, and recent oncologic and functional outcomes. Lastly, the novel characteristics of distal rectal cancer, such as pelvic sidewall and inguinal lymph node metastases, will be discussed along with its tailored and individualized treatment approach.

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Section: Surgical Managementmentioning

confidence: 99%

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Varela

Kim

2021

Ann Coloproctol

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“…An alternative to DST is hand-sewn coloanal anastomosis (CAA), which is traditionally reserved for patients with ultralow rectal tumours requesting restorative surgery [8] or in cases of technical difficulties whereby a low colorectal anastomosis is converted to a CAA [9]. CAA is associated with high rates of morbidity, with reported rates of overall morbidity up to 47%, anastomotic leakage rates of 8.5% and an increased risk of long-term bowel dysfunction [10].…”

Section: Introductionmentioning

confidence: 99%

IDEAL Stage 2a/b prospective cohort study of transanal transection and single‐stapled anastomosis for rectal cancer

Harji,

Fernandez,

Boissieras

et al. 2023

Colorectal Disease

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AimThere are several anastomotic techniques available to facilitate restorative rectal cancer surgery after total mesorectal excision (TME), including double‐stapled anastomosis (DST) and handsewn coloanal anastomosis (CAA). However, to date no one technique is superior with regard to anastomotic leakage (AL) or functional outcomes. Transanal transection single‐stapled anastomosis (TTSS) aims to overcome some of the technical challenges and offer comparable clinical and functional outcomes to traditional anastomotic techniques. The aim of this study was to explore the role of TTSS in modern rectal cancer surgery and to provide comparative clinical and functional outcome data with DST and CAA.MethodA prospective cohort study was undertaken to assess the safety and clinical and patient‐reported outcomes associated with the TTSS procedure. All patients undergoing sphincter‐preserving surgery for rectal cancer with an anastomosis performed within 6 cm of the anal verge between January 2016 and April 2021 were prospectively enrolled into this study. Clinical and patient‐reported outcome data, including low anterior resection syndrome (LARS) assessment, were collected. The primary endpoint was anastomotic leakage within 30 days.ResultsA total of 275 patients participated in this study, with 70 (25%) patients undergoing a TTSS, 110 (40%) undergoing a DST and 95 (35%) undergoing a CAA. Patients undergoing a CAA had more distal tumours than those having a TTSS or DST, with a median tumour height of 5, 7 and 9 cm (p < 0.001), respectively. We observed a statistically significant reduction in AL in the TTSS group compared with the DST group, with rates of 8.6% versus 20.9% (p = 0.028). There was no difference in LARS scores between patients undergoing TTSS and DST (p = 0.228), while patients with a CAA had worse LARS scores than TTSS patients (p = 0.002).ConclusionTTSS is a technically safe and feasible anastomotic technique in rectal cancer surgery as an alternative to DST and CAA. Its advantages over DST are a reduced AL rate and, over CAA, improved function. It should therefore be considered as an alternative technique to improve clinical and patient‐reported outcomes in restorative rectal cancer surgery.

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Critical surgical errors by junior fellows and trainees in low rectal cancer surgery: How to overcome?(A cross-sectional study)

Cited by 2 publications

References 22 publications

Surgical Treatment of Low-Lying Rectal Cancer: Updates

Surgical Treatment of Low-Lying Rectal Cancer: Updates

IDEAL Stage 2a/b prospective cohort study of transanal transection and single‐stapled anastomosis for rectal cancer

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