A Step Toward NOTES Total Mesorectal Excision for Rectal Cancer: Endoscopic Transanal Proctectomy. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Tuech, Jean-Jacques; Karoui, Mehdi; Lelong, Bernard; De Chaisemartin, Cécile; Bridoux, Valerie; Manceau, Gilles; Delpero, Jean-Robert; Hanoun, Laurent; Michot, Francis
• Is Part Of: Annals of surgery. Volume 261:Issue 2(2015:Feb.)
• Publication Date: 2015-02
• Subjects: endoscopy -- laparoscopy -- proctectomy -- rectal cancer -- transanal -- total mesorectal excision; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000994
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Background: Previous publications have suggested that endoscopic transanal proctectomy (ETAP) is a promising technique and may be an alternative to conventional low anterior resection for rectal cancer. The aim of this study was to evaluate the technical feasibility of ETAP, with a particular focus on postoperative and oncological results and on functional outcomes. Methods: This study was a multicenter prospective study of unselected consecutive patients with low rectal cancer requiring proctectomy and coloanal anastomosis. All patients underwent a standardized procedure. The study endpoints were the safety and adequacy of the oncological resection criteria. All patients were evaluated with the Wexner Fecal Incontinence Questionnaire after stoma closure. Results: Fifty-six consecutive patients (41 men) underwent ETAP between February 2010 and June 2012. The median age was 65 years (39–83), and the median body mass index was 27 (20-42). No intraoperative complications were encountered. There was no postoperative mortality, and the morbidity rate was 26%. The mesorectum was complete in 47 cases (84%) and nearly complete in 9 cases (16%). The median number of lymph nodes retrieved was 12 (range, 7–29) per patient. The median radial and distal margins were 8 mm (0–20) and 10 mm (3–40), respectively. R0 resection was achieved in 53 patients (94.6%). The median Wexner score was 4 (3–12). Thirteen (28%) patients reported stool fragmentation and difficult evacuation. Conclusions: ETAP is a feasible alternative surgical option to conventional laparoscopy for rectal resection and may represent a promising step toward rectal natural orifice transluminal endoscopic surgery (NOTES). Abstract : This multicenter study of 56 patients confirms that endoscopic transanal proctectomy (ETAP) is a promising technique for low anterior resection and may represent a step toward rectal NOTES surgery. ETAP permits safe oncologic resection for low rectal cancer.