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Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study

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Abstract

Background

Surgery for low rectal cancer remains a challenge when a standard laparoscopic approach is used. Transanal endoscopic total mesorectal excision (TME) has been shown to be feasible and to be associated with a low conversion rate. Combining the transanal and transabdominal single-port approaches (with an abdominal single port implanted in the future stoma and extraction site) could allow TME with minimal wound trauma, low morbidity, and faster recovery. The aim of the current study was to assess the short- and mid-term results of this technique.

Methods

We conducted a prospective single-centre study of consecutive patients presenting with low rectal cancer requiring a conservative proctectomy with a manual coloanal anastomosis between January 2012 and April 2015.

Results

During the study period, 41 patients were recruited. Conversion to open surgery was required in only one patient (2.4%). The median operating time was 358.5 min (range 300–600 min). Partial intersphincteric resection was necessary for 15 patients (36.6%). The specimens were mostly extracted via the abdominal access (n = 34) without wound complications. The mean number of lymph nodes harvested was 12.7 (range 6–24 lymph nodes). Specimens were graded as complete (n = 31) or nearly complete (n = 10) in all of the patients, and the circumferential resection margin positivity was 4.9%. Intraoperative morbidity rate was 4.9%, and the 30-day morbidity rate was 24.4% (n = 10). Sixty per cent (n = 6) of the patients with 30-day morbidity were Dindo I–II. At a median follow-up of 29 months, overall and disease-free survival rates were 97.5 and 80.5%, respectively. The stoma-free survival rate was 95.1%.

Conclusions

Combining an endoscopic transanal TME and a single laparoscopic ileostomy-site proctectomy is a promising minimally invasive approach for the treatment of low rectal cancer.

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Acknowledgements

The authors thank Mrs. Sandra Cournier, from the Clinical Research Department (DRCI) in Paoli Calmettes Institute for revising the paper.

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Authors and Affiliations

  1. Department of Digestive Surgical Oncology, Paoli Calmettes Institute, 232 Bd de Sainte Marguerite, 13009, Marseille, France

    H. Meillat, C. de Chaisemartin, R. Fara, J. R. Delpero & B. Lelong

  2. Department of Biopathology, Paoli Calmettes Institute, Marseille, France

    F. Poizat

  3. Digestive Endoscopy Unit, Paoli Calmettes Institute, Marseille, France

    E. Bories

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  1. H. Meillat
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  2. C. de Chaisemartin
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  3. F. Poizat
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  6. J. R. Delpero
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Correspondence to H. Meillat.

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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.

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Informed consent was obtained from all individual participants included in this study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Meillat, H., de Chaisemartin, C., Poizat, F. et al. Combined NOTES total mesorectal excision and single-incision laparoscopy principles for conservative proctectomy: a single-centre study. Tech Coloproctol 21, 43–51 (2017). https://doi.org/10.1007/s10151-016-1568-6

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  • DOI: https://doi.org/10.1007/s10151-016-1568-6

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