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

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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 Med J [Internet]. 2023Mar.6 [cited 2023Dec.5];25(1):41-5. Available from: http://zmj.zsmu.edu.ua/article/view/264119

Issue

Vol. 25 No. 1 (2023): Zaporozhye medical journal

Section

Original research

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