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Surgical Endoscopy

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01-05-2021 | Rectal Cancer | Dynamic Manuscript

Transanterior obturator nerve gateway: a novel approach to achieving intracorporeal distal rectal transection for ultralow rectal cancer

Authors: Jianqiang Tang, Hekai Chen, Junguang Liu, Aimin Gong, Xiping Ding, Yuanlian Wan, Xin Wang

Published in: Surgical Endoscopy | Issue 5/2021

Abstract

Background

Intracorporeal rectal transection at the anorectal junction for ultralow rectal cancer is technically difficult due to pelvic width and limited roticulation, which might require a transanal transection or an oblique transection with multiple firings. These procedures were reported to be associated with the increased risk of morbidity. To address these problems, we presented a novel technique Transanterior Obturator Nerve Gateway (TANG) to transect rectum for ultralow rectal cancer and evaluated its safety and feasibility in this study.

Methods

A total of 210 consecutive patients who underwent laparoscopic coloanal anastomosis with or without partial intersphincteric resection (CAA/pISR) for rectal cancers between January 2017 and January 2020 were included. Eighty of these patients were analyzed using propensity score matching (PSM). The perioperative characteristics, TANG-related variables, and genitourinary and anal function outcomes were analyzed.

Results

Among these enrolled patients, 170 patients underwent traditional transection, and 40 underwent TANG transection; the patients were matched to include 40 patients in each group by PSM. After PSM, there were no significant differences in the operating time (p = 0.351) or bleeding volume (p = 0.474) between the two groups. However, the TANG group had fewer cases of conversion to transanal transection (0 vs. 13, p < 0.001). Moreover, the patients in TANG group had a more desirable transection with longer distal resection margin (1.7 vs. 1.1 cm, p < 0.001), shorter stapling line (6.6 vs. 10.3 cm, p < 0.001) and fewer stapler firings (p < 0.001). The overall postoperative complication rates and genitourinary and anal function outcomes were not significantly different between the two groups.

Conclusions

The TANG approach appears to be a safe, feasible and effective approach for intracorporeal ultralow rectal transection with more distal resection, more vertical transection and fewer stapler firings.

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Brannigan AE, De Buck S, Suetens P et al (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision. Surg Endosc Other Interven Tech 20:952–955CrossRef

Delgado S, Mombla′n D, Salvador L, Bravo R, Castells A, Ibarzabal A, Pique′ JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients; lessons learned from >200 patients. Surg Endosc 18:1457–1462CrossRef

Vithiananthan S, Cooper Z, Betten K, Stapleton GS, Carter J, Huang EH, Whelan RL (2001) Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection. Dis Colon Rectum 44:927–935CrossRef

Ito M, Sugito M, Kobayashi A et al (2008) Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 23:703–707CrossRef

Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg 209:694–701CrossRef

Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899CrossRef

Hotta T, Takifuji K, Yokoyama S, Matsuda K, Oku Y, Hashimoto T, Yamamoto N, Yamaue H (2011) Rectal transection by the Nelaton catheter pulling method during a laparoscopic low anterior resection. Dis Colon Rectum 54:495–500CrossRef

Park SJ, Choi SI, Lee SH, Lee KY (2010) Endo-satinsky clamp for rectal transection during laparoscopic total mesorectal excision. Dis Colon Rectum 53:355–359CrossRef

Bi L, Deng X, Meng X, Yang X, Wei M, Wu Q, Ren M, Wang Z (2020) Ligating the rectum with cable tie facilitates rectum transection in laparoscopic anterior resection of rectal cancer. Langenbecks Arch Surg 405:233–239CrossRef

10.

Brannigan AE, De Buck S, Suetens P, Penninckx F, Hoore D (2006) Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge. Surg Endosc 20:952–955CrossRef

11.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

12.

Chi P, Huang SH, Lin HM, Lu XR, Huang Y, Jiang WZ, Xu ZB, Chen ZF, Sun YW, Ye DX (2015) Laparoscopic transabdominal approach partial intersphincteric resection for low rectal cancer: surgical feasibility and intermediate-term outcome. Ann Surg Oncol 22:944–951CrossRef

13.

Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J, Parneix M (1999) Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum 42:1168–1175CrossRef

14.

Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, Leung WW (2008) Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol 15:2418–2425CrossRef

15.

Gokce AH, Ozkan H (2019) Erectile dysfunction after surgery for rectal cancer: a prospective study. Turk J Surg 35:293–298CrossRef

16.

Hou XT, Pang D, Lu Q, Yang P, Jin SL, Zhou YJ, Tian SH (2015) Validation of the Chinese version of the low anterior resection syndrome score for measuring bowel dysfunction after sphincter-preserving surgery among rectal cancer patients. Eur J Oncol Nurs 19:495–501CrossRef

17.

Nevler A (2014) The epidemiology of anal incontinence and symptom severity scoring. Gastroenterol Rep 2:79–84CrossRef

18.

Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, Kang SB, Kim JY, Lee KY, Kim BC, Bae BN, Son GM, Lee SI, Kang H (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257:665–671CrossRef

19.

Qu H, Liu Y, Bi DS (2015) Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 29:3608–3617CrossRef

20.

den Dulk M, Marijnen CA, Collette L, Putter H, Pahlman L, Folkesson J, Bosset JF, Rodel C, Bujko K (2009) Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 96:1066–1075CrossRef

21.

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

22.

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Hanna GB, Mortensen NJ, Tekkis PP (2019) Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg 269:700–711CrossRef

23.

Sylla P, Knol JJD, Andrea AP, Perez RO, Atallah SB, Penna M, Hompes R, Wolthuis A, Rouanet P, Fingerhut A (2019) Urethral injury and other urologic injuries during transanal total mesorectal excision: an international collaborative study. Ann Surg. https://doi.org/10.1097/SLA.0000000000003597CrossRefPubMed

24.

Wasmuth HH, Faerden AE, Myklebust TA, Pfeffer F, Norderval S, Riis R, Olsen OC, Lambrecht JR, Korner H, Larsen SG, Forsmo HM, Baekkelund O, Lavik S, Knapp JC, Rashid G (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–130CrossRef

25.

Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148:65–71CrossRef

26.

Caulfield H, Hyman NH (2013) Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg 148:177–182CrossRef

27.

Perez RO, Sao Juliao GP, Vailati BB, Fernandez LM, Mattacheo AE, Konishi T (2018) Lateral node dissection in rectal cancer in the era of minimally invasive surgery: a step-by-step description for the surgeon unacquainted with this complex procedure with the use of the laparoscopic approach. Dis Colon Rectum 61:1237–1240CrossRef

28.

Ito M, Kobayashi A, Fujita S, Mizusawa J, Kanemitsu Y, Kinugasa Y, Komori K, Ohue M, Ota M, Akazai Y, Shiozawa M, Yamaguchi T, Akasu T, Ya M (2018) Urinary dysfunction after rectal cancer surgery: results from a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for clinical stage II or III lower rectal cancer (Japan Clinical Oncology Group Study, JCOG0212). Eur J Surg Oncol 44:463–468CrossRef

29.

Saito S, Fujita S, Mizusawa J, Kanemitsu Y, Saito N, Kinugasa Y, Akazai Y, Ota M, Ohue M, Komori K, Shiozawa M, Yamaguchi T, Akasu T, Moriya Y (2016) Male sexual dysfunction after rectal cancer surgery: results of a randomized trial comparing mesorectal excision with and without lateral lymph node dissection for patients with lower rectal cancer: Japan Clinical Oncology Group Study JCOG0212. Eur J Surg Oncol 42:1851–1858CrossRef

Title: Transanterior obturator nerve gateway: a novel approach to achieving intracorporeal distal rectal transection for ultralow rectal cancer
Authors: Jianqiang Tang
Hekai Chen
Junguang Liu
Aimin Gong
Xiping Ding
Yuanlian Wan
Xin Wang
Publication date: 01-05-2021
Publisher: Springer US
Keywords: Rectal Cancer
Rectal Cancer
Published in: Surgical Endoscopy / Issue 5/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08208-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Transanterior obturator nerve gateway: a novel approach to achieving intracorporeal distal rectal transection for ultralow rectal cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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