The Importance of the Pathologist’s Role in Assessment of the Quality of the Mesorectum

Bosch, Steven L.; Nagtegaal, Irıs D.

doi:10.1007/s11888-012-0124-7

Cited by 76 publications

(68 citation statements)

References 38 publications

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“…Seventeen of these patients (95 %) had a diverting loop ileostomy, and the time elapsed to the stoma closure was 19.9 weeks (range 1-49). The mean length of hospital stay was 9 days (range [7][8][9][10][11][12][13][14][15][16][17][18][19]. Histological analysis of the specimen revealed negative margins in all patients.…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, functional and oncologic outcomes were found to be satisfactory. Furthermore, it is known [12] that the quality of mesorectal excision is an important factor related to incidence rate of local recurrence, regardless of the positive edge of the section. On the other hand, a demanding anatomical situation (narrow pelvis and/or a high BMI) may increase the difficulty of performing a proper TME [13,14], even in the case of laparoscopic resection [9].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a demanding anatomical situation (narrow pelvis and/or a high BMI) may increase the difficulty of performing a proper TME [13,14], even in the case of laparoscopic resection [9]. According to a recent meta-analysis, the percentage of sub-optimal TME reaches up to 15 % of cases [12], also in published studies from referral centers. Otherwise, DEPA 'down to up' TME Updates Surg enables the access in 'front' of distal mesorectal end, which is notoriously the anatomical most difficult dissection, improving the surgical act quality and the oncological outcome.…”

Section: Discussionmentioning

confidence: 99%

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The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes

et al. 2015

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Laparoscopic access in low anterior rectal resection is widely adopted, performing an 'up-to-down' dissection. The aim of this study is to present and analyze the outcomes of a novel surgical 'down-to-up' total mesorectal excision technique that could obviate to the well-known issues of the standard treatment. 18 suitable patients underwent double endolaparoscopic pelvic access (DEPA) 'down-to-up' technique. DEPA TME was completed in all patients, with intact mesorectum. Mean operative time was 365 min (range 280-510 min). The morbidity rate was 22%, including three radiologically detected leakage (grade A) and one pelvic abscess, requiring only a conservative management. Mortality rate at 30 and 90 days was 0%. Resection margins were negative in all patients. A median of 11 nodes (range 5-19) was retrieved per specimen. Mean length of hospital stay was 9 days (range 7-19 days). Patients were followed for an average of 14 months (range 0-42 months), with no recurrence. Despite exiguous patient's sample in this pilot study, transanal endoscopic TME with laparoscopic assistance seems to be feasible and safe, and is a promising alternative to open and laparoscopic TME. However, a conspicuous functional and oncologic long-term evaluation is required, before the widespread adoption could be recommended.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes

et al. 2015

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“…Mesorectal integrity has been demonstrated to be one of the most important factors of both local and systemic tumor relapse, so it has been the priority objective throughout 37 . A meta-analysis of the quality of the specimen after open TME 38 showed the proportion of complete, nearly complete, and incomplete TME was 56.4%, 29.0%, and 14.6%, respectively, being the risk of local and overall recurrence associated with incomplete specimens. In the COLOR II trial 4 macroscopically complete resected specimens were recorded in 88% in the laparoscopic group and 92% in the open group.…”

Section: Discussionmentioning

confidence: 99%

Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients

Lacy

Tasende

Delgado

et al. 2015

Journal of the American College of Surgeons

305

263

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“…Properly conducted TME reduces the recurrence rate to < 10% and increases overall 5-year survival to over 80% [4] . The Dutch TME trial [5] confirmed the above results, clearly stating an increased risk of local tumor recurrence for patients who had undergone a potentially curative procedure with incomplete mesorectal excision, as compared to patients in whom the specimen showed a completely resected mesorectum [6] . Laparoscopy offers better visualization of the pelvic cavity and therefore facilitates mobilization of the rectum [7] .…”

Section: Introductionmentioning

confidence: 72%

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

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The Importance of the Pathologist’s Role in Assessment of the Quality of the Mesorectum

Cited by 76 publications

References 38 publications

The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes

The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes

Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

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