Laparoscopy-Assisted Transanal Total Mesorectal Excision.

BACKGROUND: Rectal cancer located in distal third still remains a technical challenge for surgeons. Transanal total mesorectal excision with laparoscopic assistance is quite new surgical approach for rectal cancer treatment that seems to solve some of the associated technical issues. The aim of the study was to present our experience in laparoscopy-assisted transanal total mesorectal excision. MATERIALS AND METHODS: After obtaining approval from the local Ethics Committee, a single centre prospective double-arm comparative non-randomized trial was initiated. With recruiting still in progress at present, between 27.02.2017 and 01.10.2017 four laparoscopy-assisted transanal total mesorectal excision procedures and two laparoscopic total mesorectal excisions were performed in the department of Endoscopic Endocrine Surgery and Coloproctolgy at the Military Medical Academy in Sofia. RESULTS: There is no conversion in both groups. No postoperative mortality 30 days after surgery. The quality of total mesorectal excision was satisfactory in all patients estimated by the Quirque classification. There was no distal or proximal tumor involvement of surgical margins. In one of the cases, we reported positive circumferential resection margin. We had two cases with postoperative morbidity. CONCLUSION: Transanal total mesorectal excision with laparoscopic assistance is quite new minimally invasive surgical approach for rectal cancer treatment. Avoiding the procedure-related complications during the learning curve is essential before applying the method to every patient. Multicenter randomized control trial is needed so that we could answer the questions raised in this study.

Rational surgical aggression in multimodal treatment of liver colorectal metastases.

BACKGROUND/AIMS: The purpose of this study was to analyze the influence of aggressive surgery regarding resection of liver metastases (LM) from colorectal cancer (CRC) on morbidity, mortality and survival rates and to establish utility of multimodal strategies increasing resectability rates of liver metastases. METHODOLOGY: Two hundred twenty eight consecutive patients with CRC LMs operated from January 2004 to October 2009 were presented. They underwent 137 curative liver resections. We have used extended criteria for respectability including the possibility to spare 2 adjacent liver segments. Multimodal approaches meaning transformation of primary unresectable LMs to resectable ones were used in 46 cases. During the final decision intraoperative ultrasonography took an important part. RESULTS: The resectability in presented series was 46% for synchronous LM and 76% for metachronous. Aggressive surgical approach was applied in 75 patients. The average rate of intraoperative hemorrhage was 300mL. Postoperative complications occurred in 25.5% of patients. Two patients died postoperatively. CONCLUSIONS: Rational surgical behavior in context of multimodal approach to LMs of CRC can increase chances of resectability and long-term survival without influencing morbidity and mortality.