Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study

Velthuis, Simone; Helbach, M. Veltcamp; Tuynman, Jurriaan B.; Le, Thuy-Nga; Bonjer, H. Jaap; Sietses, C.

doi:10.1007/s00464-015-4089-x

Cited by 53 publications

(26 citation statements)

References 19 publications

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“…The reported incidence of presacral abscesses was not increased compared to the abdominal TME procedure. This is unexpected since it has been shown that increased bacterial load is present in the pelvis after TaTME [19]. The low rate of conversions compared to reported laparoscopic TME seems a major improvement and might be accounted as a benefit of TaTME.…”

Section: Discussionmentioning

confidence: 93%

“…Urethra injury or pelvic side wall injury with bleeding and nerve damage has not been documented for the conventional low anterior resection (LAR) [2–11]. In addition, increased bacterial load as is observed after TaTME might induce the occurrence of presacral abscesses [19]. Most importantly, data regarding oncological outcome after TaTME for mid and low rectal cancer are still scarce [12–18].…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review

et al. 2016

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Transanal total mesorectal excision (TaTME) has been developed to improve quality of TME for patients with mid and low rectal cancer. However, despite enthusiastic uptake and teaching facilities, concern exists for safe introduction. TaTME is a complex procedure and potentially a learning curve will hamper clinical outcome. With this systematic review, we aim to provide data regarding morbidity and safety of TaTME. A systematic literature search was performed in MEDLINE (PubMed), EMBASE (Ovid) and Cochrane Library. Case reports, cohort series and comparative series on TaTME for rectal cancer were included. To evaluate a potential effect of case volume, low-volume centres (n ≤ 30 total volume) were compared with high-volume centres (n > 30 total volume). Thirty-three studies were identified (three case reports, 25 case series, five comparative studies), including 794 patients. Conversion was performed in 3.0% of the procedures. The complication rate was 40.3, and 11.5% were major complications. The quality of the mesorectum was “complete” in 87.6%, and the circumferential resection margin (CRM) was involved in 4.7%. In low- versus high-volume centres, the conversion rate was 4.3 versus 2.7%, and major complication rates were 12.2 versus 10.5%, respectively. TME quality was “complete” in 80.5 versus 89.7%, and CRM involvement was 4.8 and 4.5% in low- versus high-volume centres, respectively. TaTME for mid and low rectal cancer is a promising technique; however, it is associated with considerable morbidity. Safe implementation of the TaTME should include proctoring and quality assurance preferably within a trial setting.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review

et al. 2016

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“…Under these conditions, there is a theoretical risk of bacterial contamination and tumour spillage, even with meticulous closure of the rectal lumen after endoanal dissection. Volthuis et al recently described the correlation between bacterial contamination (positive culture) and septic pelvic complications [42], reporting an alarming rate of 39% of patients with a positive culture and 17.4% of patients with septic complications (nearly half of the patients with a positive culture).…”

Section: Discussionmentioning

confidence: 99%

A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design

et al. 2017

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BackgroundTotal mesorectal excision is the standard surgical treatment for mid- and low-rectal cancer. Laparoscopy represents a clear leap forward in the management of rectal cancer patients, offering significant improvements in post-operative measures such as pain, first bowel movement, and hospital length of stay. However, there are still some limits to its applications, especially in difficult cases. Such cases may entail either conversion to an open procedure or positive resection margins. Transanal endoscopic proctectomy (ETAP) was recently described and could address the difficulties of approaching the lower third of the rectum. Early series and case-control studies have shown favourable short-term results, such as a low conversion rate, reduced hospital length of stay and oncological outcomes comparable to laparoscopic surgery. The aim of the proposed study is to compare the rate of positive resection margins (R1 resection) with ETAP versus laparoscopic proctectomy (LAP), with patients randomly assigned to each arm.Methods/designThe proposed study is a multicentre randomised trial using two parallel groups to compare ETAP and LAP. Patients with T3 lower-third rectal adenocarcinomas for whom conservative surgery with manual coloanal anastomosis is planned will be recruited. Randomisation will be performed immediately prior to surgery after ensuring that the patient meets the inclusion criteria and completing the baseline functional and quality of life tests. The study is designed as a non-inferiority trial with a main criterion of R0/R1 resection. Secondary endpoints will include the conversion rate, the minimal invasiveness of the abdominal approach, postoperative morbidity, the length of hospital stay, mesorectal macroscopic assessment, functional urologic and sexual results, faecal continence, global quality of life, stoma-free survival, and disease-free survival at 3 years. The inclusion period will be 3 years, and every patient will be followed for 3 years. The number of patients needed is 226.DiscussionThere is a strong need for optimal evaluation of the ETAP because of substancial changes in the operative technique. Assessment of oncological safety and septic risk, as well as digestive and urological functional results, is particularily mandatory. Moreover, benefits of the ETAP technique could be demonstrated in post-operative outcome.Trial registrationClinicalTrial.gov: NCT02584985. Date and version identifier: Version n°2 – 2015 July 6.

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“…TaTME has its detractors[89,90], the operative technique is not standardized, and involves dissecting from within the rectum outwards into the mesorectum with the theoretical risk of contaminating this space and the peritoneal cavity with bacteria[91] or worse malignant cells[90], even when there is routine performance of iodine-based distal rectal washout. While the two-team approach offers efficiency in execution, the procedure calls for just that, two teams, or at least two sets of instruments for the transanal and transabdominal approaches.…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

Plummer

Leake

Albert

2017

WJGS

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Over the last decade, with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer, there has been a significant increase in the literature regarding treatment options available to patients affected by this disease. That treatment related decisions should be made at a high volume multidisciplinary tumor board, after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision (TME) are accepted standard of care. More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders, which may be appropriate in 20% of patients. Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only, with transanal minimal invasive surgery (TAMIS) because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon, emerging as the leading option. Recent trials have raised concerns about the oncologic outcomes of the standard “top-down” TME hence transanal TME (TaTME “bottom-up”) approach has gained popularity as an alternative. The challenges are many, with a dearth of evidence of the oncologic superiority in the long-term for any given option. However, this review highlights recent advances in the role of chemoradiation only for complete pathologic responders, TAMIS for highly selected early rectal cancer patients and TaTME as options to improve cure rates whilst maintaining quality of life in these patients, while we await the results of further definitive trials being currently conducted.

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Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study

Abstract: Transanal TME procedures are associated with positive cultures in more than one-third of the patients. In these patients, postoperative locoregional infectious complications are more common.

Cited by 53 publications

References 19 publications

Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review

Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review

A multicentre randomised controlled trial to evaluate the efficacy, morbidity and functional outcome of endoscopic transanal proctectomy versus laparoscopic proctectomy for low-lying rectal cancer (ETAP-GRECCAR 11 TRIAL): rationale and design

Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery

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