Notes total mesorectal excision (TME) for patients with rectal neoplasia

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dc.contributor.author Chouillard, E.
dc.contributor.author Khoury, G.
dc.contributor.author Chahine, E.
dc.contributor.author Vincent-Bonnet, B.
dc.contributor.author G|umbs, A.
dc.contributor.author Azoulay, D.
dc.contributor.author Abdalla, Eddie
dc.date.accessioned 2015-11-20T07:20:44Z
dc.date.available 2015-11-20T07:20:44Z
dc.date.copyright 2014
dc.date.issued 2017-10-12
dc.identifier.issn 0930-2794 en_US
dc.identifier.uri http://hdl.handle.net/10725/2636
dc.description.abstract Background Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy are emerging, minimally invasive techniques. Total mesorectal excision (TME), the gold standard treatment for patients with resectable distal rectal tumors, is usually performed in an “up-to-down” approach, either laparoscopically or via open techniques. A transanal, “down-to-up” TME has already been reported. Our NOTES variant of TME (NOTESTME) is based on a transperineal approach without any form of abdominal assistance. The aim was to reduce further the invasiveness of the procedure while optimizing the anatomical definition of the distal mesorectum. This approach may lead to reduced postoperative pain, decreased hernia formation and improved cosmesis when compared to standard laparoscopy. Methods NOTESTME was attempted in 16 patients with distal rectal neoplasia (i.e., distal edge of the tumor lower than the pouch of Douglas, between 0 and 12 cm from the dentate line). Additional inclusion criteria consisted of an ASA status ≤III and the absence of previous abdominal surgery. Results NOTESTME was completed in all patients. Additional abdominal, single-incision laparoscopic assistance was required in 6 (38 %) patients. Mean operative time was 265 min (range 155–440 min). The morbidity rate was 18.8 % (two small bowel obstructions and one pelvic abscess), requiring re-operation in each case. No leaks occurred, and the mortality rate at 30 and 90 days was 0 %. Resection margins were negative in all patients. A median of 17 nodes (range 12–81) was retrieved per specimen. Mean length of hospital stay was 10 days (range 4–29 days). Patients were followed for an average of 7 months (range 3–23 months). Conclusion NOTESTME was feasible and safe in this series of patients with mid- or low rectal tumors. The short-term mortality and morbidity rates are acceptable, with no apparent compromise in the oncological quality of the resection. Larger, randomized controlled trials with long-term follow-up are warranted. en_US
dc.language.iso en en_US
dc.title Notes total mesorectal excision (TME) for patients with rectal neoplasia en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle A preliminary experience en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal Surgical Endoscopy en_US
dc.journal.volume 28 en_US
dc.journal.issue 11 en_US
dc.article.pages 3150-3157 en_US
dc.keywords Surgery en_US
dc.keywords Rectum en_US
dc.keywords Mesorectum en_US
dc.keywords NOTES en_US
dc.keywords Single-port en_US
dc.keywords Cancer en_US
dc.identifier.doi http://dx.doi.org/10.1007/s00464-014-3573-z en_US
dc.identifier.ctation 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. Surgical endoscopy, 28(11), 3150-3157. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://link.springer.com/article/10.1007/s00464-014-3573-z

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