{"title":"局部晚期直肠癌伴侧淋巴结转移的两组经肛门中直肠全切除术和盆腔侧淋巴结、髂主血管和盆腔神经丛整体切除术","authors":"Ikuma Shioi, Hiroomi Ogawa, Nobuhiro Hosoi, Arisa Yamaguchi, Takayoshi Watanabe, Nobuhiro Nakazawa, Yuta Shibasaki, Takuya Shiraishi, Katsuya Osone, Takuhisa Okada, Akihiko Sano, Makoto Sakai, Makoto Sohda, Ken Shirabe, Hiroshi Saeki","doi":"10.1097/SLE.0000000000001268","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Here, we describe the precise surgical technique for a novel procedure involving 2-team transanal total mesorectal excision with en bloc lateral pelvic lymph node (LPLN) dissection combined with resection of the involved main internal iliac vessels and pelvic plexus.</p><p><strong>Methods: </strong>From September 2020 to May 2023, 4 patients underwent the procedure at our hospital.</p><p><strong>Results: </strong>The operation time and blood loss were 272 to 412 minutes and 10 to 124 mL, respectively. No patients required conversion to open surgery or exhibited Clavien-Dindo grade III or worse postoperative complications, although 2 developed grade II urinary dysfunction. All surgical margins were negative.</p><p><strong>Conclusions: </strong>Our novel 2-team method can facilitate safe and satisfactory surgery, even for highly advanced rectal cancer. The transanal approach offers excellent visibility and operability, even during LPLN and adjacent structure dissection. Furthermore, initial dissection of the distal branches of the iliac vessels prevents excessive lymphatic tissue congestion, facilitating easier, and clearer dissection.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Two-Team Transanal Total Mesorectal Excision and En Bloc Resection of the Lateral Pelvic Lymph Nodes, Main Iliac Vessels, and Pelvic Plexus for Locally Advanced Rectal Cancer With Lateral Lymph Node Metastasis.\",\"authors\":\"Ikuma Shioi, Hiroomi Ogawa, Nobuhiro Hosoi, Arisa Yamaguchi, Takayoshi Watanabe, Nobuhiro Nakazawa, Yuta Shibasaki, Takuya Shiraishi, Katsuya Osone, Takuhisa Okada, Akihiko Sano, Makoto Sakai, Makoto Sohda, Ken Shirabe, Hiroshi Saeki\",\"doi\":\"10.1097/SLE.0000000000001268\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Here, we describe the precise surgical technique for a novel procedure involving 2-team transanal total mesorectal excision with en bloc lateral pelvic lymph node (LPLN) dissection combined with resection of the involved main internal iliac vessels and pelvic plexus.</p><p><strong>Methods: </strong>From September 2020 to May 2023, 4 patients underwent the procedure at our hospital.</p><p><strong>Results: </strong>The operation time and blood loss were 272 to 412 minutes and 10 to 124 mL, respectively. No patients required conversion to open surgery or exhibited Clavien-Dindo grade III or worse postoperative complications, although 2 developed grade II urinary dysfunction. All surgical margins were negative.</p><p><strong>Conclusions: </strong>Our novel 2-team method can facilitate safe and satisfactory surgery, even for highly advanced rectal cancer. The transanal approach offers excellent visibility and operability, even during LPLN and adjacent structure dissection. Furthermore, initial dissection of the distal branches of the iliac vessels prevents excessive lymphatic tissue congestion, facilitating easier, and clearer dissection.</p>\",\"PeriodicalId\":22092,\"journal\":{\"name\":\"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/SLE.0000000000001268\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/SLE.0000000000001268","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:在此,我们描述了一种新型手术的精确手术技术,该手术包括2组经肛门全直肠系膜切除术,同时进行盆腔外侧淋巴结(LPLN)清扫术,并切除受累的髂内主血管和盆腔神经丛:2020年9月至2023年5月,4例患者在我院接受了该手术:手术时间和失血量分别为272至412分钟和10至124毫升。没有患者需要转为开放手术或出现 Clavien-Dindo III 级或更严重的术后并发症,但有 2 名患者出现了 II 级排尿功能障碍。所有手术切缘均为阴性:结论:我们新颖的两组手术方法即使对高位直肠癌也能提供安全、满意的手术效果。经肛门方法具有良好的可视性和可操作性,即使在LPLN和邻近结构解剖时也是如此。此外,对髂血管远端分支的初步解剖可防止淋巴组织过度充血,使解剖更容易、更清晰。
Two-Team Transanal Total Mesorectal Excision and En Bloc Resection of the Lateral Pelvic Lymph Nodes, Main Iliac Vessels, and Pelvic Plexus for Locally Advanced Rectal Cancer With Lateral Lymph Node Metastasis.
Background: Here, we describe the precise surgical technique for a novel procedure involving 2-team transanal total mesorectal excision with en bloc lateral pelvic lymph node (LPLN) dissection combined with resection of the involved main internal iliac vessels and pelvic plexus.
Methods: From September 2020 to May 2023, 4 patients underwent the procedure at our hospital.
Results: The operation time and blood loss were 272 to 412 minutes and 10 to 124 mL, respectively. No patients required conversion to open surgery or exhibited Clavien-Dindo grade III or worse postoperative complications, although 2 developed grade II urinary dysfunction. All surgical margins were negative.
Conclusions: Our novel 2-team method can facilitate safe and satisfactory surgery, even for highly advanced rectal cancer. The transanal approach offers excellent visibility and operability, even during LPLN and adjacent structure dissection. Furthermore, initial dissection of the distal branches of the iliac vessels prevents excessive lymphatic tissue congestion, facilitating easier, and clearer dissection.
期刊介绍:
Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.