Simple instruments facilitating achievement of transanal total mesorectal excision in male patients

• Published in: World journal of gastroenterology : WJG Vol. 23; no. 31; pp. 5798 - 5808
• Main Authors: Xu, Chang, Song, Hua-Yu, Han, Shao-Liang, Ni, Shi-Chang, Zhang, Hu-Xiang, Xing, Chun-Gen
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.08.2017
• Subjects: Anal Canal - surgery; Disease-Free Survival; Follow-Up Studies; Humans; Incidence; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Mesocolon - surgery; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Operative Time; Organ Sparing Treatments - adverse effects; Organ Sparing Treatments - economics; Organ Sparing Treatments - instrumentation; Organ Sparing Treatments - methods; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum - surgery; Retrospective Studies; Retrospective Study; Transanal Endoscopic Surgery - adverse effects; Transanal Endoscopic Surgery - economics; Transanal Endoscopic Surgery - instrumentation; Transanal Endoscopic Surgery - methods; Treatment Outcome; Intersphincteric resection; Rectal neoplasm; Total mesorectal excision; Transanal approach; Long-term outcome; Local recurrence
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v23.i31.5798

AIM To assess the efficacy of a modified approach with transanal total mesorectal excision(ta TME) using simple customized instruments in male patients with low rectal cancer.METHODS A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor(tumor diameter ≥ 40 mm). Forty-one patients(group A) underwent a classical approach of transabdominal total mesorectal excision(TME) and transanal intersphincteric resection(ISR), and the other 74 patients(group B) underwent a modified approach with transabdominal TME,transanal ISR, and ta TME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform ta TME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.RESULTS All 115 patients had successful sphincter preservation. The operative time in group B(240 min, range: 160-330 min) was significantly shorter than that in group A(280 min, range: 200-360 min; P = 0.000). Co m pa r e d w it h g r o up A, m o r e c o m p le t e d is t a l mesorectum and total mesorectum were achieved in group B(100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo followup, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant(5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION Retrograde ta TME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.