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Transperineal minimally invasive abdomino-perineal resection: preliminary outcomes and future perspectives

  • Simone ArolfoEmail author
  • Alberto Bullano
  • Marco Ettore Allaix
  • Alberto Arezzo
  • Mario Morino
Original Article
  • 35 Downloads

Abstract

Abdomino-perineal resection (APR) for rectal cancer is challenging, due to the difficult exposure of the surgical field. Many investigations proved worst results in terms of circumferential resection margin (CRM) involvement compared to rectal anterior resection (RAR) with total mesorectal excision (TME). Extralevator abdomino-perineal excision (ELAPE) improved oncologic outcomes, but is burdened by important limitations (positioning, wound closure). Applying the concept of transanal minimally invasive surgery (TAMIS) and the experience in transanal TME (TaTME) to the perineal phase of APR could overcome these limitations. A series of consecutive cases of transperineal minimally invasive APR was matched with an historical series of standard laparoscopic APR. Primary endpoints were global complication rate and CRM involvement, secondary endpoints were operative time, time to flatus and oral feeding and length of hospital stay. Fifteen patients underwent a transperineal minimally invasive APR for cancer, median age was 65 (49–88) years, median distance from the anal verge was 3 (2–5) cm and six patients underwent neoadjuvant chemo-radiotherapy. No intraoperative complications occurred in both groups; need of post-operative blood transfusions was significantly higher in the traditional laparoscopic APR group. No differences were reported in terms of wound dehiscence between the two groups. Positive CRM was reduced in transperineal minimally invasive APR versus standard laparoscopic APR, but the difference was not statistically significant. Transperineal minimally invasive APR appears to be safe and could improve post-operative and oncologic outcomes by means of better vision and reduced surgical trauma.

Keywords

Rectal cancer Abdomino-perineal resection Minimally invasive surgery Circumferential resection margin 

Notes

Compliance with ethical standards

Conflict of interest

None.

Research involving human participants and/or animals

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National).

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

13304_2019_692_MOESM1_ESM.mpg (704.7 mb)
Supplementary material 1 (MPG 721637 KB)

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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  1. 1.Department of Surgical SciencesUniversity of TorinoTurinItaly

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