Skip to main content

Advertisement

Log in

The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Laparoscopic access in low anterior rectal resection is widely adopted, performing an ‘up-to-down’ dissection. The aim of this study is to present and analyze the outcomes of a novel surgical ‘down-to-up’ total mesorectal excision technique that could obviate to the well-known issues of the standard treatment. 18 suitable patients underwent double endolaparoscopic pelvic access (DEPA) ‘down-to-up’ technique. DEPA TME was completed in all patients, with intact mesorectum. Mean operative time was 365 min (range 280–510 min). The morbidity rate was 22 %, including three radiologically detected leakage (grade A) and one pelvic abscess, requiring only a conservative management. Mortality rate at 30 and 90 days was 0 %. Resection margins were negative in all patients. A median of 11 nodes (range 5–19) was retrieved per specimen. Mean length of hospital stay was 9 days (range 7–19 days). Patients were followed for an average of 14 months (range 0–42 months), with no recurrence. Despite exiguous patient’s sample in this pilot study, transanal endoscopic TME with laparoscopic assistance seems to be feasible and safe, and is a promising alternative to open and laparoscopic TME. However, a conspicuous functional and oncologic long-term evaluation is required, before the widespread adoption could be recommended.

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Baek SJ, Kim J, Kwak J, Kim SH (2013) Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy? World J Gastroenterol 19(32):5309–5313

    Article  PubMed Central  PubMed  Google Scholar 

  2. Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner DW (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 

  3. Lacy AM, Adelsdorfer C, Delgado S, Sylla P, Rattner DW (2013) Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surg Endosc 27:339–346

    Article  PubMed  Google Scholar 

  4. Atallah S, Albert M, deBeche-Adams T, Nassif G, Polavarapu H, Larach S (2013) Transanal minimally invasive surgery for total mesorectal excision (TME-TAMIS): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 17(3):321–325

    Article  CAS  PubMed  Google Scholar 

  5. Rahbari N et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010(147):339–351

    Article  Google Scholar 

  6. Peeters K, Tollenaar M, Marijnen M et al (2005) Group risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005(92):211–216

    Article  Google Scholar 

  7. Rutkowski A, Bujko K, Nowacki MP et al (2008) Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe ? Ann Surg Oncol 15(11):3124–3131

    Article  PubMed  Google Scholar 

  8. Shirouzu K, Isomoto H, Kakegawa T (1995) Distal spread of rectal cancer and optimal distal margin of resection for distal sphincter preserving surgery. Cancer 76:388–392

    Article  CAS  PubMed  Google Scholar 

  9. van der Pas MHGM et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomized, phase 3 trial. Lancet Oncol 14:210–218

    Article  PubMed  Google Scholar 

  10. Ito M, Sugito M, Kobayashhi A, Nishizawa Y, Tsunoda Y, Saito N (2008) Relationship between multiple numbers during rectal division of stapler firings and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707

    Article  PubMed  Google Scholar 

  11. Brannigan AE, De Buck S, Suetens P, Penninckx F, DhHoore A (2006) Following laparoscopic intracorporeal rectal stapling total mesorectal excision: overcoming a challenge. Surg Endosc 20(6):952–955

    Article  CAS  PubMed  Google Scholar 

  12. Bosh LS, Nagtegaal ID (2012) The importance of the pathologist’s role in assessment of the quality of the mesorectum. Curr Colorectal Cancer Rep 8:90–98

    Article  Google Scholar 

  13. Boyle KM, Petty D, Chalmers AG et al (2005) MRI assessment of the bony pelvis may help predict resectability of rectal cancer. Colorectal Dis 7(3):232–240

    Article  CAS  PubMed  Google Scholar 

  14. Leonard D, Penninckx F, Fieuws S et al (2010) Factors predicting the quality of total mesorectal excision for rectal cancer. Ann Surg 252(6):982–988

    Article  PubMed  Google Scholar 

  15. Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E (2014) NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 28(11):3150–3157. doi:10.1007/s00464-014-3573-z

    Article  CAS  PubMed  Google Scholar 

  16. Feussner H, Fiolka A, Schneider A, Gillen S, Kranzfelder M, Friess H, Wilhelm D (2011) Safe sigmoid access for natural orifice transluminal endoscopic surgery (NOTES) color. Dis. 13:55–58

    Google Scholar 

  17. Sylla P, Turner GB, Hsu M, Brugge W (2010) Rattner DW (2010) Survival study of natural orifice translumenal endoscopic surgery for rectosigmoid resection using transanal endoscopic microsurgery with or without transgastric endoscopic assistance in a swine model. Surg Endosc 24:2022–2030

    Article  PubMed  Google Scholar 

  18. Emhoff IA, Lee GC (2014) Sylla P (2014) Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES). Dig Endosc 26:29–42

    Article  PubMed  Google Scholar 

  19. Rieder E, Spaun G, Khajanchee Y, Martinec D, Arnold B, Sehdev A, Swanstrom L, Whiteford M (2011) A natural orifice transrectal approach for oncologic resection of the rectosigmoid: an experimental study and comparison with conventional laparoscopy. Surg Endosc 25:3357–3363

    Article  PubMed  Google Scholar 

  20. Marks J, Mizrahi B, Dalane S, Nweze I, Marks G (2010) Laparoscopic transanal abdominal transanal resection with sphincter preservation for rectal cancer in the distal 3 cm of the rectum after neoadjuvant therapy. Surg Endosc 24:2700–2707

    Article  CAS  PubMed  Google Scholar 

  21. Han Y, He Y, Zhang H, Lv K, Zhang Y, Lin M, Yin L (2013) Total laparoscopic sigmoid and rectal surgery in combination with transanal endoscopic microsurgery: a preliminary evaluation in China. Surg Endosc 27:518–524

    Article  PubMed  Google Scholar 

  22. Dumont F, Goeré D, Honoré C, Elias D (2012) Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum 55:996–1001

    Article  PubMed  Google Scholar 

  23. Velthuis S, van den Boezem PB, van der Peet DL, Cuesta MA, Sietses C (2013) Feasibility study of transanal total mesorectal excision. Br J Surg 100:828–831

    Article  CAS  PubMed  Google Scholar 

  24. Sylla P, Bordeianou LG, Berger D, Han KS, Lauwers GY, Sahani DV, Sbeih MA, Lacy AM, Rattner DW (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 

  25. Sylla P, Rattner DW, Delgado S, Lacy AM (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24:1205–1210

    Article  PubMed  Google Scholar 

  26. Morcos B, Baker B, Al Masri M, Haddad H, Hashem S (2010) Lymph node yield in rectal cancer surgery: effect of preoperative chemoradiotherapy. Eur J Surg Oncol 36(4):345–349

    Article  CAS  PubMed  Google Scholar 

  27. Muratore A, Mellano A, Marsanic P, De Simone M (2015) Transanal total mesorectal excision (taTME) for cancer located in the lower rectum: short- and mid-term results. Eur J Surg Oncol 41(4):478–483. doi:10.1016/j.ejso.2015.01.009

    Article  CAS  PubMed  Google Scholar 

  28. Fernandez-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, del Gobbo GD, DeLacy B, Balust J, Lacy AM (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 

  29. Kneist W, Rink AD, Kauff DW, Konerding MA, Lang H (2015) Topography of the extrinsic internal anal sphincter nerve supply during laparoscopic-assisted TAMIS TME: five key zones of risk from surgeons’ view. Int J Colorectal Dis 30:71–78

    Article  PubMed  Google Scholar 

  30. Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788

    Article  CAS  PubMed  Google Scholar 

  31. Wexner SD, Berho M (2014) Transanal TAMIS total mesorectal excision (TME)—a work in progress. Tech Coloproctol 18:423–425

    Article  CAS  PubMed  Google Scholar 

  32. Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61

    Article  CAS  PubMed  Google Scholar 

  33. Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

Drs. Paolo De Paolis, Alberto Bona, Maria Paola Bellomo, Andrea Borasi, and Dario Borreca have no conflicts of interests or financial ties to disclose.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dario Borreca.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borreca, D., Bona, A., Bellomo, M.P. et al. The new approach to the rectal cancer: ‘down-to-up’ double endolaparoscopic pelvic access. Preliminary evaluation of outcomes. Updates Surg 67, 293–299 (2015). https://doi.org/10.1007/s13304-015-0306-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-015-0306-3

Keywords

Navigation