The role and place of transanal endoscopic resections in rectal cancer

Authors

DOI:

https://doi.org/10.14739/2310-1210.2023.1.264119

Keywords:

rectal cancer, sentinel lymph node, indocyanine green, transanal endoscopic microsurgery

Abstract

The aim of the work is to improve the algorithm of intraoperative diagnosis of rectal cancer metastasis in order to optimize surgical intervention and reduce the number of intraoperative and postoperative complications.

Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: group 1 – patients with stage I RC (T1–2N0M0), and group 2 – stage II RC (T3N0M0), who underwent intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS).

The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and late (recurrent rectal cancer) complications.

Results. The patients of group 1 had no MTS lesions of the sentinel lymph nodes, the surgical intervention was limited to transanal microsurgery due to this fact. Among the complications were the following: bleeding – 2.2 %; intraoperative perforation of the intestinal wall – 5.6 %. No purulent-septic cases, no recurrences of rectal cancer were detected.

In group 2, 36 (38.3 %) out of 94 patients had MTS detected intraoperatively in the sentinel lymph nodes which required a low anterior rectal resection with total mesorectumectomy. Among the complications was bleeding – 6.3 %. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (12.8 %) patients.

Conclusions. Performing transanal endoscopic resections in patients with stage I RC and especially stage II RC is possible only under the conditions of mandatory intraoperative staining and urgent histological examination of the sentinel lymph nodes. The extent of the surgical intervention is determined on the operating table based on urgent histological examination results. When MTS lesions of the mesorectal sentinel lymph nodes are detected, the operation should be continued with mandatory mesorectumectomy.

Author Biographies

R. P. Nikitenko, Odesa National Medical University, Ukraine

MD, PhD, Associate Professor of the Department of Surgery 1

V. M. Zaporozhan, Odesa National Medical University, Ukraine

MD, PhD, DSc, Professor, Academician of the NAMS of Ukraine

K. O. Vorotyntseva, Odesa National Medical University, Ukraine

MD, PhD, Assistant of the Department of Surgery 1

Ye. A. Koichev, Odesa National Medical University, Ukraine

MD, PhD, Assistant of the Department of Surgery 1, Odesa National Medical University, Ukraine

References

Grubnik, V. V., Nikitenko, R. P., Degtyarenko, S. P., & Grubnik, V. V. (2019). Transanalni endoskopichni operatsii pry rektalnykh pukhlunakh [Тransanal endoscopic operations in rectal tumors]. Klinichna khirurhiia, 86(3), 15-18. [in Ukrainian]. https://doi.org/10.26779/2522-1396.2019.03.15

Nikitenko, R. P., Vorotyntseva, K. O., Degtyarenko, S. P., & Stepanovichus, O. M. (2021). Uskladnennia transanalnoi endoskopichnoi rezektsii pry raku priamoi kyshky [Complications of transanal endoscopic resection in cancer recti]. Klinichna khirurhiia, 88(11-12), 11-14. [in Ukrainian]. https://doi.org/10.26779/2522-1396.2021.11-12.11

Konishi, T., Kuroyanagi, H., Oya, M., Ueno, M., Fujimoto, Y., Akiyoshi, T., Yoshimatsu, H., Watanabe, T., Yamaguchi, T., & Muto, T. (2011). Multimedia article. Lateral lymph node dissection with preoperative chemoradiation for locally advanced lower rectal cancer through a laparoscopic approach. Surgical endoscopy, 25(7), 2358-2359. https://doi.org/10.1007/s00464-010-1531-y

Quadros, C. A., Falcão, M. F., Carvalho, M. E., Ladeia, P. A., & Lopes, A. (2012). Metastases to retroperitoneal or lateral pelvic lymph nodes indicated unfavorable survival and high pelvic recurrence rates in a cohort of 102 patients with low rectal adenocarcinoma. Journal of surgical oncology, 106(6), 653-658. https://doi.org/10.1002/jso.23144

Lezoche, E., Baldarelli, M., Lezoche, G., Paganini, A. M., Gesuita, R., & Guerrieri, M. (2012). Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. The British journal of surgery, 99(9), 1211-1218. https://doi.org/10.1002/bjs.8821

Morino, M., Risio, M., Bach, S., Beets-Tan, R., Bujko, K., Panis, Y., Quirke, P., Rembacken, B., Rullier, E., Saito, Y., Young-Fadok, T., Allaix, M. E., European Association for Endoscopic Surgery, & European Society of Coloproctology (2015). Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surgical endoscopy, 29(4), 755-773. https://doi.org/10.1007/s00464-015-4067-3

Bilhim, T., Pereira, J. A., Tinto, H. R., Fernandes, L., Duarte, M., O'Neill, J. E., & Pisco, J. M. (2013). Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography. Surgical and radiologic anatomy : SRA, 35(6), 517-522. https://doi.org/10.1007/s00276-012-1068-y

Allaix, M. E., Arezzo, A., Arolfo, S., Caldart, M., Rebecchi, F., & Morino, M. (2013). Transanal endoscopic microsurgery for rectal neoplasms. How I do it. Journal of gastrointestinal surgery, 17(3), 586-592. https://doi.org/10.1007/s11605-012-2060-x

Wu, Y., Wu, Y. Y., Li, S., Zhu, B. S., Zhao, K., Yang, X. D., & Xing, C. G. (2011). TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepato-gastroenterology, 58(106), 364-368.

Denzer, U., Beilenhoff, U., Eickhoff, A., Faiss, S., Hüttl, P., In der Smitten, S., Jakobs, R., Jenssen, C., Keuchel, M., Langer, F., Lerch, M. M., Lynen Jansen, P., May, A., Menningen, R., Moog, G., Rösch, T., Rosien, U., Vowinkel, T., Wehrmann, T., Weickert, U., … Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (2015). S2k-Leitlinie Qualitätsanforderungen in der gastrointestinalen Endoskopie, AWMF Register Nr. 021-022. Erstauflage 2015 [S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021-022]. Zeitschrift fur Gastroenterologie, 53(12), E1-E227. https://doi.org/10.1055/s-0041-109598

Mölle, B., Ommer, A., Lange, J., & Girona, J. (2018). Chirurgische Proktologie. Springer. https://doi.org/10.1007/978-3-662-54682-6

Schmidt, A., Bauerfeind, P., Gubler, C., Damm, M., Bauder, M., & Caca, K. (2015). Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy, 47(8), 719-725. https://doi.org/10.1055/s-0034-1391781

Watanabe, T., Muro, K., Ajioka, Y., Hashiguchi, Y., Ito, Y., Saito, Y., Hamaguchi, T., Ishida, H., Ishiguro, M., Ishihara, S., Kanemitsu, Y., Kawano, H., Kinugasa, Y., Kokudo, N., Murofushi, K., Nakajima, T., Oka, S., Sakai, Y., Tsuji, A., Uehara, K., … Japanese Society for Cancer of the Colon and Rectum (2018). Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. International journal of clinical oncology, 23(1), 1-34. https://doi.org/10.1007/s10147-017-1101-6

Stevenson, A. R. L., Solomon, M. J., Brown, C. S. B., Lumley, J. W., Hewett, P., Clouston, A. D., Gebski, V. J., Wilson, K., Hague, W., Simes, J., & Australasian Gastro-Intestinal Trials Group (AGITG) ALaCaRT investigators (2019). Disease-free Survival and Local Recurrence After Laparoscopic-assisted Resection or Open Resection for Rectal Cancer: The Australasian Laparoscopic Cancer of the Rectum Randomized Clinical Trial. Annals of surgery, 269(4), 596-602. https://doi.org/10.1097/SLA.0000000000003021

Penna, M., Hompes, R., Arnold, S., Wynn, G., Austin, R., Warusavitarne, J., Moran, B., Hanna, G. B., Mortensen, N. J., Tekkis, P. P., & TaTME Registry Collaborative (2017). Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Annals of surgery, 266(1), 111-117. https://doi.org/10.1097/SLA.0000000000001948

Smith, J. J., Strombom, P., Chow, O. S., Roxburgh, C. S., Lynn, P., Eaton, A., Widmar, M., Ganesh, K., Yaeger, R., Cercek, A., Weiser, M. R., Nash, G. M., Guillem, J. G., Temple, L. K. F., Chalasani, S. B., Fuqua, J. L., Petkovska, I., Wu, A. J., Reyngold, M., Vakiani, E., … Paty, P. B. (2019). Assessment of a Watch-and-Wait Strategy for Rectal Cancer in Patients With a Complete Response After Neoadjuvant Therapy. JAMA oncology, 5(4), e185896. https://doi.org/10.1001/jamaoncol.2018.5896

Published

2023-03-06

How to Cite

1.
Nikitenko RP, Zaporozhan VM, Vorotyntseva KO, Koichev YA. The role and place of transanal endoscopic resections in rectal cancer. Zaporozhye Medical Journal [Internet]. 2023Mar.6 [cited 2024Jul.20];25(1):41-5. Available from: http://zmj.zsmu.edu.ua/article/view/264119