Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer

Yasukawa, Daiki; Hori, Tomohide; Kadokawa, Yoshio; Kato, Shigeru; Aisu, Yuki; Hasegawa, Suguru

doi:10.1007/s00464-018-6316-8

Cited by 15 publications

(15 citation statements)

References 35 publications

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“…Comparable results regarding this technique were reported by Yasukawa et al, who described a comparative cohort of 21 minimally invasive TpAPE versus 29 conventional APE with a positive margin rate (2/21 versus 3/29), a lower severe perineal wound infection rate (0/21 versus 5/29) and reduced length of stay (median 14 versus 23 days) with no conversion, no mortality, and no increase in major morbidity [31].…”

Section: Discussionmentioning

confidence: 62%

“…A consecutive cohort of patients who underwent TpAPE for primary rectal cancer was identified at five centers (two in The Netherlands, one in Taiwan, one in Canada, and one in the United Kingdom). This group consisted of patients that had either a bilateral ELAPE, an unilateral ELAPE or APE with resection of the entire external sphincter [31,32]. Intersphincteric APE's were excluded.…”

Section: Patientsmentioning

confidence: 99%

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Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

et al. 2020

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Background Abdominoperineal excision (APE) for rectal cancer is associated with a relatively high risk of positive margins and postoperative morbidity, particularly related to perineal wound healing problems. It is unknown whether the use of a minimally invasive approach for the perineal part of these procedures can improve postoperative outcomes without oncological compromise. The aim of this study was to evaluate the feasibility of minimally invasive transperineal abdominoperineal excision (TpAPE) Methods This multicenter retrospective cohort study included all patients having TpAPE for primary low rectal cancer. The primary endpoint was the intraoperative complication rate. Secondary endpoints included major morbidity (Clavien-Dindo ≥ 3), histopathology results, and perineal wound healing. Results A total of 32 TpAPE procedures were performed in five centers. A bilateral extralevator APE (ELAPE) was performed in 17 patients (53%), a unilateral ELAPE in 7 (22%), and an APE in 8 (25%). Intraoperative complications occurred in five cases (16%) and severe postoperative morbidity in three cases (9%). There were no perioperative deaths. A positive margin (R1) was observed in four patients (13%) and specimen perforation occurred in two (6%). The unilateral extralevator TpAPE group had worse specimen quality and a higher proportion of R1 resections than the bilateral ELAPE or standard APE groups. The rate of uncomplicated perineal wound healing was 53% (n = 17) and three patients (9%) required surgical reintervention. Conclusions TpAPE seems to be feasible with acceptable perioperative morbidity and a relatively low rate of perineal wound dehiscence, while histopathological outcomes remain suboptimal. Additional evaluation of the viability of this technique is needed in the form of a prospective trial with standardization of the procedure, indication, audit of outcomes and performed by surgeons with vast experience in transanal total mesorectal excision.

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Section: Discussionmentioning

confidence: 62%

Section: Patientsmentioning

confidence: 99%

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

et al. 2020

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“…The median distance of distal resection in our study was reasonably adequate. Additionally, it is easier to dissect the pelvic outer frame, such as the pelvic fascia, sacral periosteum, and pelvic floor muscles, via the anal side than through the abdominal approach [26]. However, the advantages of the Ta approach may be associated with certain complications; for instance, it may be difficult to return to the optimal layer after traversing a deeper layer during dissection.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion

et al. 2020

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Background Transanal (Ta) pelvic exenteration is a promising, minimally invasive method for treating locally advanced colorectal cancer. However, since it is technically difficult to perform, Ta pelvic exenteration is rarely reported in locally advanced T4 rectal cancer cases. The aim of this study was to evaluate the feasibility of transabdominal laparoscopy-assisted Ta pelvic exenteration. Methods Six patients (4 males and 2 females) had laparoscopy-assisted Ta total or posterior pelvic exenteration for locally advanced or recurrent colorectal cancer cases at the Nagasaki University Hospital between September 2018 and August 2019. Clinical and pathological outcomes were measured and analyzed. Results The median operation time and intraoperative blood loss were 481 (range 456-709) minutes and 352.5 (range 257-1660) ml, respectively. R0 resection was achieved in all cases, and no patient required open surgery. Two patients had grade 3 complications (Clavien-Dindo) or higher. There was no mortality, and no reoperation was required. Conclusions The results suggest that laparoscopic-assisted Ta pelvic exenteration is an acceptable procedure, may help overcome the current technical difficulties, and may improve outcomes in patients with locally advanced rectal cancer.

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“…Abdominoperineal resection (APR) is another indication for this approach, and is often referred to as "transperineal APR" 9,10) . This approach gives the option, depending on the extent of the tumor, of several perianal dissection lines, including intersphincteric, extralevator, and ischioanal 11) .…”

Section: Operative Proceduresmentioning

confidence: 99%

Transanal TME: new standard or fad?

Hasegawa

Yoshida

Morimoto

et al. 2019

J Anus Rectum Colon

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Transanal total mesorectal excision (taTME) has been developed to overcome the difficulty of laparoscopic dissection and transection in the deep pelvis. TaTME has several clinical benefits over laparoscopic surgery, such as better exposure of the distal rectum and direct determination of distal resection margin. Although evidence demonstrating the true benefits of taTME over laparoscopic TME (LapTME) is still insufficient, accumulating data have revealed that, as compared with LapTME, taTME is associated with shorter operative time and a lower conversion rate without jeopardizing other short-term outcomes. However, taTME is a technically demanding procedure with specific complications such as urethral injury, and so sufficient experience of LapTME and step-by-step acquisition of the skills needed for this procedure are requisite. The role of transanal endoscopic surgery is expected to change, along with the recent progress in the treatment of rectal cancer, such as robotic surgery and the watch-and-wait strategy. Optimization of treatment will be needed in the future in terms not only of oncological but also of functional outcomes.

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Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer

Cited by 15 publications

References 35 publications

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

Transperineal minimally invasive APE: preliminary outcomes in a multicenter cohort

Feasibility of laparoscopic-assisted transanal pelvic exenteration in locally advanced rectal cancer with anterior invasion

Transanal TME: new standard or fad?

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