Long-term outcomes of transanal total mesorectal excision for rectal cancer: what could we do to improve them?

BACKGROUND: Long-term outcomes of transanal mesorectal excision are still controversial. The aim of this study was to analyze long-term oncological and functional results of TaTME. METHODS: Fifty patients with mid-low rectal cancer were included: 20 underwent TaTME and 30 laparoscopic total mesorectal excision. Clinical characteristics of patients and tumors and quality indicators for rectal surgery were described. Long-term functional outcomes were compared in two groups (TaTME vs. laTME). Local recurrence rate was calculated. Kaplan-Meier curves were performed for disease-free and overall survival and log-rank test was used to compare two groups. RESULTS: There were not significant differences between two groups in sex, age ASA Score, neoadjuvant therapy, tumor stage and quality indicators of rectal surgery. After a median follow-up of 46 (41-51) months functional outcomes were significantly worse in TaTME group in terms of rates of maior low anterior resection syndrome score (10% vs. 0%, P=0.009), faucal incontinence (15% vs. 3%, P=0.017), urinary disfunction (10% vs. 0%, P=0.009) and sexual disfunction (15% vs. 13%, P=0.047). Only one patient presented local recurrence (TaTME group, ypT3N0). Overall survival at 1 and 3 years were 92.6% and 90% respectively and disease-free survival at 1 and 3 years were 96% and 90% respectively. There were not significant differences in overall survival and disease-free survival between two groups. CONCLUSIONS: Overall survival and disease-free survival after TaTME for rectal cancer were similar to laparoscopic total mesorectal excision. However functional outcomes were worse after TaTME.

Quality indicators of transanal total mesorectal excision (TaTME) for rectal cancer

Introduction: Transanal total mesorectal excision (TaTME) has revolutionized the surgical techniques for lower-third rectal cancer. The aim of the present study was to analyze the outcomes of quality indicators of TaTME for rectal cancer compared with laparoscopic TME (LaTME). Methods: A cohort prospective study with 50 (14 female and 36male) patients, with a mean age of 67 (range: 55.75 to 75.25) years, who underwent surgery for rectal cancer. In total, 20 patients underwent TaTME, and 30, LaTME. Every TaTME procedure was performed by experienced colorectal surgeons. The sample was divided into two groups (TaTME and LaTME), and the quality indicators of the surgery for rectal cancer were analyzed. Results: There were no statistically significant differences regarding the patients and the main characteristics of the tumor (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], tumoral stage, neoadjuvant therapy, and distance from the tumor to the external anal margin) between the two groups. The rates of: postoperativemorbidity (TaTME: 35%; LaTME: 30%; p=0.763);mortality (0%); anastomotic leak (TaTME: 10%; LaTME: 13%; p=0.722); wound infection (TaTME: 0%; LaTME: 3.3%; p=0.409); reoperation (TaTME: 5%; LaTME: 6.6%; p=0.808); and readmission (TaTME: 5%; LaTME: 0%; p=0.400), as well as the length of the hospital stay (TaTME: 13.5 days; LaTME: 11 days; p=0.538), were similar in both groups. There were no statistically significant differences in the rates of positive circumferential resection margin (TaTME: 5%; LaTME: 3.3%; p=0.989) and positive distal resection margin (TaTME: 0%; LaTME: 3.3%; p=0.400), the completeness of the TME (TaTME: 100%; LaTME: 100%), and the number of lymph nodes harvested (TaTME: 15; LaTME: 15.5; p=0.882) between two groups. Conclusion: Transanal total mesorectal excision is a safe and feasible surgical procedure for middle/lower-third rectal cancer. (AU)

Esofagitis enfisematosa con perforación gástrica / Emphysematous esophagitis with gastric perforation

La esofagitis enfisematosa es una entidad extremadamente infrecuente sin prácticamente ningún caso descrito en la literatura. Presentamos el caso de una paciente con esofagitis y gastritis enfisematosa con afectación de toda la pared del esófago y el estómago al diagnóstico. Fue intervenida quirúrgicamente por perforación gástrica en dos ocasiones, realizándose cierre primario en ambas con evolución posterior favorable. Pese a la gran extensión de la esófago-gastritis enfisematosa al diagnóstico y la presencia de una perforación gástrica, es seguro realizar un manejo semejante a la gastritis enfisematosa siendo lo más conservadores posibles en caso de precisar cirugía

Emphysematous esophagitis is an extremely rare disease and there are very few previous reports in the literature. We report a case of emphysematous esophagitis and gastritis with complete affectation of the gastric and esophageal wall at diagnosis. Two surgical interventions were performed due to gastric perforation that was treated in both cases with primary closure. The post-operative recovery was satisfactory. Despite the large emphysematous esophago-gastritis affectation at diagnosis and the presence of gastric perforation, it is safe to perform the same management principles as with emphysematous gastritis. This should be as conservative as possible in case a surgical procedure is required

Emphysematous esophagitis with gastric perforation.

Emphysematous esophagitis is an extremely rare disease and there are very few previous reports in the literature. We report a case of emphysematous esophagitis and gastritis with complete affectation of the gastric and esophageal wall at diagnosis. Two surgical interventions were performed due to gastric perforation that was treated in both cases with primary closure. The post-operative recovery was satisfactory. Despite the large emphysematous esophago-gastritis affectation at diagnosis and the presence of gastric perforation, it is safe to perform the same management principles as with emphysematous gastritis. This should be as conservative as possible in case a surgical procedure is required.

Análisis de la calidad asistencial en el tratamiento quirúrgico del cáncer colorrectal. Estudio de ámbito nacional. Resultados del seguimiento / Analysis of the quality of care in surgical treatment of colorectal cancer: National study. Follow-up results

OBJETIVOS: Tomando como referencia la casuística del «Estudio sobre la calidad asistencial en el cáncer colorrectal», llevado a cabo por la Asociación Española de Cirujanos en el año 2008, se analiza el seguimiento de los pacientes. MÉTODO: Estudio multicéntrico, descriptivo, prospectivo y longitudinal de pacientes intervenidos de forma programada por cáncer colorrectal (CCR). Han participado 35 hospitales, aportando 334 pacientes. Se han recogido datos del seguimiento: supervivencia, recidivas y complicaciones. RESULTADOS: Seguimiento medio 28,61 ± 11,32 meses. Seguimiento por Cirugía General 69,2%, recidiva tumoral fue del 23,6%, el 83,3% sistémica; el 28,2% fue sometido a cirugía de rescate. La supervivencia global fue del 76,6% y la supervivencia libre de enfermedad del 65,6% (26,49 ± 11,90 meses). La mortalidad relativa fue del 12,6%. El porcentaje de eventraciones fue del 5,8% y la obstrucción intestinal del 3,5%. CONCLUSIONES: El nivel de calidad y los resultados del seguimiento de los pacientes intervenidos por CCR en España son similares a los observados en la literatura internacional. Existen áreas de mejora seguimiento, diagnóstico más temprano, aumentar tratamientos adyuvantes y neoadyuvantes y establecer la escisión total del mesorrecto como cirugía estándar en cáncer de recto

OBJECTIVES: Using the cases included in the study on the quality of care in colorectal cancer conducted by the Spanish Association of Surgeons in 2008, we present follow-up data. METHOD: Multicenter, descriptive, longitudinal and prospective study of patients operated on a scheduled basis for colorectal cancer. 35 hospitals have contributed data on 334 patients. Follow-up data included: survival, recurrence and complications. RESULTS: Mean follow-up was 28.61±11.32 months. Follow-up by the surgeon was 69.2%, tumor recurrence was 23.6%, in 83.3% it was systemic; and 28.2% underwent salvage surgery. Overall survival was 76.6%, disease-free survival 65.6% (26.49 ± 11.90 months). Tumor related mortality was 12.6%. Percentage of ventral hernias was 5.8% and intestinal obstruction was 3.5%. CONCLUSIONS: Quality and results of follow-up of patients operated on for CRC in Spain are similar to those reported in the scientific literature. Areas for improvement included: follow-up, earlier diagnosis, increased adjuvant and neoadjuvant treatments and total mesorectal excision as standard surgery for rectal cancer

Analysis of the quality of care in surgical treatment of colorectal cancer: national study. Follow-up results.

OBJECTIVES: Using the cases included in the Study on the quality of care in colorectal cancer conducted by the Spanish Association of Surgeons in 2008, we present follow-up data. METHOD: Multicenter, descriptive, longitudinal and prospective study of patients operated on a scheduled basis of colorectal cancer. 35 hospitals have contributed data on 334 patients. Follow-up data: survival, recurrence and complications. RESULTS: Mean follow-up was 28.61±11.32 months. Follow-up by surgeon: 69.2%, tumor recurrence 23.6%, in 83.3% it was systemic; 28.2% underwent salvage surgery. Overall survival was 76.6%, disease-free survival 65.6% (26.49±11.90 months). Tumor related mortality was 12,6%. Percentage of ventral hernias was 5.8%, intestinal obstruction 3.5%. CONCLUSIONS: Quality and results of follow-up of patients operated on for CRC in Spain are similar to those reported in the Scientific literature. Areas for improvement: follow-up, earlier diagnosis, increase adjuvant and neoadjuvant treatments and total mesorectal excision as standard surgery for rectal cancer.