Benefit of laparoscopic two-team transanal beyond total mesorectal excision for advanced and recurrent rectal cancer with invasion: a retrospective study compared with conventional laparoscopic approach.
{"title":"Benefit of laparoscopic two-team transanal beyond total mesorectal excision for advanced and recurrent rectal cancer with invasion: a retrospective study compared with conventional laparoscopic approach.","authors":"Ikuma Shioi, Takuya Shiraishi, Yutaro Shimizu, Kosei Uehara, Takahiro Seki, Nobuhiro Hosoi, Kouhei Tateno, Mizuki Endo, Shintaro Uchida, Arisa Yamaguchi, Chika Katayama, Yuta Shibasaki, Chika Komine, Katsuya Osone, Takuhisa Okada, Akiharu Kimura, Akihiko Sano, Makoto Sakai, Ken Shirabe, Hiroshi Saeki","doi":"10.1007/s10151-025-03158-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.</p><p><strong>Methods: </strong>This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).</p><p><strong>Results: </strong>In total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.</p><p><strong>Conclusions: </strong>Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"120"},"PeriodicalIF":2.9000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102100/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Techniques in Coloproctology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10151-025-03158-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
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Abstract
Background: The optimal surgical approach for advanced or recurrent rectal cancer with invasion of adjacent structures remains controversial. This study aimed to clarify the feasibility of laparoscopic two-team transanal beyond total mesorectal excision in patients with advanced and recurrent rectal cancer with invasion.
Methods: This single-center retrospective study was conducted in a single educational hospital in Japan from January 2014 to March 2024. Patients with advanced or recurrent rectal cancer who underwent laparoscopic or two-team transanal total mesorectal excision with the resection of adjacent structures were included in the analysis. Short-term outcomes were compared between the laparoscopic and transanal approaches. The burden of medical resources was assessed using a new index, Staff Time Consumed (STC = median number of participating staff members × operation time).
Results: In total, 35 patients were included. More patients underwent preoperative treatment and lateral lymph-node dissection using the transanal approach. However, the operative time (539 and 339 min in the laparoscopic and transanal groups, respectively; p < 0.001) and total blood loss (274 and 70 mL, respectively; p = 0.008) were lower in the transanal group. Additionally, the positive resection margin was lower in the transanal group than in the laparoscopic group (28% and 0%, p = 0.021); STC was comparable between groups. There was no increase in postoperative mortality or morbidity. Patients with surgical difficulties had shorter operative times in the transanal group, and comparable STC.
Conclusions: Laparoscopic two-team transanal approach offers better short-term outcomes than the conventional approach in highly selected patients.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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