Skip to main content

Advertisement

SpringerLink
Log in

Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved?

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy are spreading worldwide. Total mesorectal excision (TME), the standard treatment for patients with distal rectal tumors, is usually performed in an “up-to-down” approach, either laparoscopically (LAPTME) or as an open procedure. We have already reported a NOTES-inspired, transanal, “down-to-up” variant of TME (NOTESTME). The main aim of this study was to assess the quality of the resected specimen in patients who had undergone either NOTESTME or LAPTME.

Methods

All patients with distal rectal neoplasia presenting between January 2011 and December 2014 were considered for the study. Additional inclusion criteria comprised American Society of Anesthesiologists score ≤ III and the absence of previous open surgery. Assignment to either group was sequential and based on the rank of inclusion in the study. The primary endpoint was the macroscopic quality of the specimen. Secondary endpoints included nerve visualization, tumor perforation, operating time, status of margins, and number of retrieved nodes.

Results

Eighteen patients (6 men, 12 women) were in the NOTESTME group and 15 (7 men, 8 women) in the LAPTME group, respectively. The TME specimen was considered complete or mainly regular in 16 patients who had undergone NOTESTME (88.9 %) and in 11 patients who had undergone LAPTME (73.3 %), (p > 0.05). During the procedure, we visually identified the neurovascular bundles of Walsh in 14 patients in the NOTESTME group (77.8 %) and in only 5 patients in the LAPTME group (33.3 %), (p < 0.05). Mean operative time was 245 min (range 155–440 min) in the NOTESTME group and 275 min (range 180–400 min) in the LAPTME group (p > 0.05). A median of 11 nodes per specimen (range 8–22 nodes) was retrieved in the NOTESTME group and 12 nodes (range 6–41 nodes) in the LAPTME group, respectively (p > 0.05). Distal and radial margins were comparable in both groups.

Conclusions

Compared to the LAPTME, the NOTESTME seems to be associated with a more frequent intraoperative identification of the sacral nerves. However, the difference in overall quality of the retrieved specimen, although favoring NOTESTME, did not reach statistical significance in this small series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Atallah S, Martin-Perez B, Keller D, Burke J, Hunter L (2015) Natural-orifice transluminal endoscopic surgery. Br J Surg 102:73–92

    Article  Google Scholar 

  2. Daher R, Chouillard E, Panis Y (2014) New trends in colorectal surgery: single port and natural orifice techniques. World J Gastroenterol 20:18104–18120

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chouillard E, Chahine E, Khoury G et al (2014) NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 28:3150–3157

    Article  CAS  PubMed  Google Scholar 

  4. Moreira-Pinto J, Lima E, Correia-Pinto J, Rolanda C (2011) Natural orifice transluminal endoscopy surgery: A review. World J Gastroenterol 17:3795–3801

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Papalampros AE (2012) Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg 204:93–102

    Article  PubMed  Google Scholar 

  6. Hu SY (2012) Application of natural orifice transluminal endoscopic surgery and laparoendoscopic single-site surgery techniques in colorectal surgery. Zhonghua Wei Chang Wai Ke Za Zhi 15:770–772

    CAS  PubMed  Google Scholar 

  7. Lacy AM, Rattner DW, Adelsdorfer C et al (2013) Transanal natural orifice transluminal endoscopic surgery (NOTES) rectal resection: “down-to-up” total mesorectal excision (TME)-short-term outcomes in the first 20 cases. Surg Endosc 27:3165–3172

    Article  PubMed  Google Scholar 

  8. Osborne AJ, Lim J, Gash KJ, Chaudhary B, Dixon AR (2013) Comparison of single-incision laparoscopic high anterior resection with standard laparoscopic high anterior resection. Colorectal Dis 15:329–333

    Article  CAS  PubMed  Google Scholar 

  9. Leroy J, Jamali F, Forbes L et al (2004) Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 18:281–289

    Article  CAS  PubMed  Google Scholar 

  10. Kellokumpu IH, Kairaluoma MI, Nuorva KP, Kautiainen HJ, Jantunen IT (2012) Short- and long-term outcome following laparoscopic versus open resection for carcinoma of the rectum in the multimodal setting. Dis Colon Rectum 55:854–863

    Article  PubMed  Google Scholar 

  11. Cecil TD, Sexton R, Moran BJ, Heald RJ (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 47:1145–1149

    Article  PubMed  Google Scholar 

  12. Tuech JJ, Karoui M, Lelong B et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261:228–233

    Article  PubMed  Google Scholar 

  13. Park SJ, Sohn DK, Chang TY et al: Korea Natural Orifice Transluminal Endoscopic Surgery (K-NOTES) Study Group (2015) Transanal natural orifice transluminal endoscopic surgery total mesorectal excision in animal models: endoscopic inferior mesenteric artery dissection made easier by a retroperitoneal approach. Ann Surg Treat Res 87:1–4

    Google Scholar 

  14. Fernández-Hevia M, Delgado S, Castells A et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261:221–227

    Article  PubMed  Google Scholar 

  15. Quirke P, Steele R, Monson J et al: MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 7:821–828

    Google Scholar 

  16. Sylla P, Bordeianou LG, Berger D et al (2013) A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer. Surg Endosc 27:3396–3405

    Article  PubMed  Google Scholar 

  17. Zhang H, Zhang YS, Jin XW, Li MZ, Fan JS, Yang ZH (2013) Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 17:117–123

    Article  CAS  PubMed  Google Scholar 

  18. Keating JP (2004) Sexual function after rectal excision. Aust NZ J Surg 74:248–259

    Article  Google Scholar 

  19. Heald RJ (1988) The ‘Holy Plane’ of rectal surgery. J R Soc Med 81:503–508

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Leão P, Goulart A, Veiga C, Cristino H, Marcos N, Correia-Pinto J, Rodrigues M, Moreno-Sanz C (2015) Transanal total mesorectal excision: a pure NOTES approach for selected patients. Tech Coloproctol 19:541–549

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Poissy/Saint-Germain-en-Laye Hospital Center, 10 rue du Champ Gaillard, 78300, Poissy, France

    E. Chouillard, B. V. Bonnet, V. Greco, E. Chahine & R. Daher

  2. Department of Pathology, Poissy/Saint-Germain-en-Laye Hospital Center, Poissy, France

    A. Regnier

  3. Department of Gastroenterology and Hepathology, Poissy/Saint-Germain-en-Laye Hospital Center, Poissy, France

    R.-L. Vitte

  4. Department of General Surgery, Saint-Joseph Hospital, Beirut, Lebanon

    J. Biagini

Authors
  1. E. Chouillard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Regnier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R.-L. Vitte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. V. Bonnet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. V. Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Chahine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Daher
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Biagini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Chouillard.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been approved by the ethics and research committee of the Poissy/Saint Germain En Laye Hospital Center.

Informed consent

All the patients signed an informed consent prior to inclusion in the study.

Additional information

On behalf of The Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), France.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chouillard, E., Regnier, A., Vitte, RL. et al. Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved?. Tech Coloproctol 20, 537–544 (2016). https://doi.org/10.1007/s10151-016-1449-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-016-1449-z

Keywords

Search

Navigation