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Endoscopic approach to rectal cancer surgery shows promise
Transanal endoscopic total mesorectal excision showed positive results in a phase 2 trial of patients with rectal cancer, according to research published in Diseases of the Colon & Rectum.
Sung Chan Park, MD, of the Center for Colorectal Cancer Research at the National Cancer Center, in Goyang, South Korea, and colleagues said that several laparoscopic techniques for total mesorectal excision (TME) have been developed in the past, but they still have relatively high conversion rates and circumferential resection margins (CRM). In a video abstract, Park noted that transanal TME could be the answer to some problems that colorectal surgeons encounter in these kinds of procedures, but more research is needed before the technique becomes widespread.
“Many colorectal surgeons may agree that the obstacles with rectal cancer surgery — narrow pelvis, limitation of movements, poor visual field — can result in some unfavorable outcomes,” he said. “After the first report on transanal TME, some benefits of this approach were proposed, such as easy ... access, straight forward dissection, and better visualization.”
Park and colleagues conducted a single-center, prospective study of 49 patients with rectal cancer located between 3 cm and 12 cm from the anal verge. Two teams of surgeons performed simultaneous transabdominal and transanal procedures for the study.
The primary endpoint was quality of TME, as well as a negative CRM. They also collected information on the number of lymph nodes harvested, operation time and 30-day postoperative complications.
The procedure was successful in 45 (91.8%) patients based on the quality of TME and CRM.
The researchers observed 30-day postoperative complications in 15 patients (30.6%), including anastomotic dehiscence (n = 7; 14.3%), urinary retention (n = 5; 10.2%), abdominal wound complications (n = 2; 4.1%) and ileus (n = 1; 2%). There was no postoperative mortality.
Park and colleagues acknowledged that their study was limited because it was conducted at a single center, and because they did not include patients with a narrow pelvis, bulky tumors or obesity. Therefore, they said their results cannot be generalized to the full population.
“The indication of transanal TME, or the real benefits of transanal TME is still under investigation,” Park said. “We still need the research from large randomized trials.” – by Alex Young
Disclosures : The authors report no relevant financial disclosures.