Midterm functional results of taTME with neuromapping for low rectal cancer

Kneist, W.; Wachter, Nicolas; Paschold, M.; Kauff, Daniel W.; Rink, Andreas D.; Lang, Hauke

doi:10.1007/s10151-015-1390-6

Cited by 48 publications

(42 citation statements)

References 32 publications

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“…Eleven studies used the Wexner score to assess the level of continence ( Table 2); two others 36,44 used the Vaizey or Kirwin score. All studies that performed a preoperative assessment of function 32,39,41 confirmed that no major preoperative deviations in Wexner score were present. Summarizing data that reported Wexner scores at specific times (3, 6, 9, 12, 18, 24 months) showed a median Wexner score at 3 months of 9 (range 1-20) 38,41,43 .…”

Section: Continencementioning

confidence: 77%

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Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Heijden

Köeter

Smits

et al. 2020

British Journal of Surgery

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Background Total mesorectal excision (TME) gives excellent oncological results in rectal cancer treatment, but patients may experience functional problems. A novel approach to performing TME is by single‐port transanal minimally invasive surgery. This systematic review evaluated the functional outcomes and quality of life after transanal and laparoscopic TME. Methods A comprehensive search in PubMed, the Cochrane Library, Embase and the trial registers was conducted in May 2019. PRISMA guidelines were used. Data for meta‐analysis were pooled using a random‐effects model. Results A total of 11 660 studies were identified, from which 14 studies and six conference abstracts involving 846 patients (599 transanal TME, 247 laparoscopic TME) were included. A substantial number of patients experienced functional problems consistent with low anterior resection syndrome (LARS). Meta‐analysis found no significant difference in major LARS between the two approaches (risk ratio 1·13, 95 per cent c.i. 0·94 to 1·35; P = 0·18). However, major heterogeneity was present in the studies together with poor reporting of functional baseline assessment. Conclusion No differences in function were observed between transanal and laparoscopic TME.

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Section: Continencementioning

confidence: 77%

“…Pontallier et al 40 38 TaTME > 12 9 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 16 (42) 34 LapTME 10 (3-20) (P = 0⋅932) 14 (41) (P = 0⋅936) Kneist et al 41 10 TaTME Baseline…”

Section: Study Characteristics and Quality Controlmentioning

confidence: 99%

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Heijden

Köeter

Smits

et al. 2020

British Journal of Surgery

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“…A factor that may influence sphincter function particularly after TaTME is the prolonged anal dilatation owing to the wide anal platforms that are involved throughout the procedure. Rates of severe low anterior resection syndrome following TaTME vary significantly in the literature, ranging from 10 to 82 per cent, although results were from very small cohorts.…”

Section: Discussionmentioning

confidence: 97%

Transanal total mesorectal excision for locally advanced middle–low rectal cancers

et al. 2019

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Background This study investigated the results of transanal total mesorectal excision (TaTME) combined with laparoscopy for locally advanced mid–low rectal cancer. Methods Patients with mid–low locally advanced rectal cancer (T3 category or above and/or N+) who underwent rectal resection with TaTME technique were enrolled prospectively. Patients who had distant metastasis, multiple malignancies, intestinal obstruction or perforation, or a clinical complete response to chemoradiotherapy were excluded. Postoperative results, including morbidity, circumferential resection margin (CRM) assessment, short‐term survival and functional outcomes, were analysed. Results Thirty‐eight patients, with 25 mid and 13 low rectal tumours, who had elective resection by TaTME from March 2015 to September 2018 were included. There were 25 men and 13 women. Mean(s.d.) age was 58·2(16·4) years and mean(s.d.) BMI was 24·2(2·5) kg/m2. Tumours were 3–9 cm from the anal verge. Mean(s.d.) duration of surgery was 210(42) min. All patients had hand‐sewn anastomoses and protective ileostomies. There were no conversions, abdominal perineal resections or postoperative deaths. Four patients had a complication, including three presacral abscesses, all managed by transanastomotic drainage. At 3 months after ileostomy closure, all patients had perfect continence. Apart from a greater tumour diameter in patients with low rectal cancers (6·0 cm versus 4·6 cm in those with mid rectal tumours; P = 0·035), clinical features were similar in the two groups. CRM positivity was greater for low than for mid rectal tumours (3 of 13 versus 0 of 25 respectively; P = 0·034), and more patients with a low tumour had TME grade 2 (4 of 13 versus 1 of 25; P = 0·038). There was no difference in oncological outcomes at 17 months. Conclusion Although this study cohort was small, special attention should be paid to bulky low rectal tumours to reduce the rate of CRM positivity.

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“…Hinterlegt mit den Tatsachen, dass Tumorhöhen bei abdominoperinealer Exstirpation in ausgewählten deutschen Kliniken bei 3 bis 4 cm ab anocutan liegen [3], die Indikation zum (partiellen) Sphinktererhalt multifaktoriell beeinflusst bleibt und dabei auch wesentlich von der Sphinkterfunktion abhängt [4], sind zur Bewertung der TaTME bei distalen Rektumkarzinomen zukünftige Subgruppenanalysen notwendig. Nicht explizit aufgeführt aber doch wichtig zur exakten Festlegung der distalen Resektionslinie bei tiefsitzenden Karzinomen ist die Beziehung zur L. dentata.…”

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Therapie von Rektumkarzinomen durch transanale totale mesorektale Exzision

Kneist

2016

coloproctology

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Therapie von Rektumkarzinomen durch transanale totale mesorektale Exzision Kommentar zur bisher größten unizentrischen Studie Originalpublikation Antonio ML et al (2015) Transanal total mesorectal exzision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415-423Fragestellung und Hintergrund. Die anatomischen Schwierigkeiten, mit denen wir bei der offenen Operation von Rektumkarzinomen konfrontiert werden, können auch durch den laparoskopischen Ansatz nicht überwunden werden. Auf der Suche nach einer Lösung tat sich ein Konzeptwechsel auf: der Zugang zum Rektum von unten. Hauptziel der Studie war es, die potenziellen Vorteile der hybriden transabdominaltransanalen totalen mesorektalen Exzision (TaTME) aufzuzeigen. Dieser Ansatz könnte die Qualität der mesorektalen Präparate verbessern. Darüber hinaus kann Proktektomie technisch einfacher und sicherer "von unten nach oben" durchgeführt werden, mit dem Ergebnis kürzerer OP-Zeiten, niedrigerer Konversionsraten und geringerer Morbidität.

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Midterm functional results of taTME with neuromapping for low rectal cancer

Abstract: Despite a small sample size and confounding factors, data indicate that taTME has the potential to preserve continence, sufficient bowel function, and urogenital function.

Cited by 48 publications

References 32 publications

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Functional complaints and quality of life after transanal total mesorectal excision: a meta-analysis

Transanal total mesorectal excision for locally advanced middle–low rectal cancers

Therapie von Rektumkarzinomen durch transanale totale mesorektale Exzision

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