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Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer

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Abstract

Background

Locally advanced rectal cancer (LARC) can involve surrounding pelvic organs requiring multivisceral resection. Extended total mesorectal excision (e-TME) or multivisceral resection is a complex procedure associated with high morbidity, mortality, and R1 resection rates. However, e-TME in LARC with surrounding organ involvement is the only potential option for cure. The study aims to assess the clinical outcome of patients requiring e-TME for LARC.

Methods

The study is a retrospective review of all patients with LARC requiring multivisceral resection (2013 to 2019). The database includes clinic-demographic profile, pelvic organ involved, operative details, resection margin status, morbidity, mortality, and survival.

Results

Seven consecutive patients (9.2%) out of 76 LARC (median age 46 years; 5 females) required multivisceral resection. The organs involved were bladder (4); posterior wall of vagina (2); and uterus (1). The en bloc resection included total cystoprostatectomy - 1; partial cystectomy - 3; posterior vaginectomy - 2; and hysterectomy - 1. Additionally, four required abdominoperineal resection. All were adenocarcinoma: stage III, with R0 resection - 76%. The overall complications were seen in 60% of patients, majority being wound related. There was no operative mortality. The median survival was 32.2 months in the entire series, while one died with the disease at a 28-month follow-up.

Conclusion

e-TME with curative intent, though a complex procedure, is associated with high wound-related morbidity, R1 resection, but improved median survival benefit.

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Authors and Affiliations

  1. Division of Surgical Gastroenterology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal

    Narendra Pandit, Kunal Bikram Deo, Sujan Gautam, Tek Narayan Yadav & Laligen Awale

  2. Division of Urology, Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal

    Awaj Kafle & Sudhir Kumar Singh

Authors
  1. Narendra Pandit
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  2. Kunal Bikram Deo
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  3. Sujan Gautam
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  4. Tek Narayan Yadav
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  5. Awaj Kafle
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  6. Sudhir Kumar Singh
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  7. Laligen Awale
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Corresponding author

Correspondence to Narendra Pandit.

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The ethical approval was obtained from BPKIHS, Ethics Committee, before the study.

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The authors declare that they have no conflict of interest.

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Pandit, N., Deo, K.B., Gautam, S. et al. Extended Total Mesorectal Excision (e-TME) for Locally Advanced Rectal Cancer. J Gastrointest Canc 53, 253–258 (2022). https://doi.org/10.1007/s12029-020-00562-1

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  • DOI: https://doi.org/10.1007/s12029-020-00562-1

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