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The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience

Received: 22 August 2016     Accepted: 30 August 2016     Published: 18 September 2016
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Abstract

Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients’ demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.

Published in Journal of Surgery (Volume 4, Issue 5)
DOI 10.11648/j.js.20160405.15
Page(s) 114-121
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Laparoscopic, TME, Abdominoperineal Resection, Rectal Cancer, CRM, Outcome

References
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Cite This Article
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    Samy Abbas Elbaz, Waleed Hassan Omar, Hosam Ghazy Elbanna, Mohamed Youssef, Sameh Hany Emile, et al. (2016). The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience. Journal of Surgery, 4(5), 114-121. https://doi.org/10.11648/j.js.20160405.15

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    ACS Style

    Samy Abbas Elbaz; Waleed Hassan Omar; Hosam Ghazy Elbanna; Mohamed Youssef; Sameh Hany Emile, et al. The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience. J. Surg. 2016, 4(5), 114-121. doi: 10.11648/j.js.20160405.15

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    AMA Style

    Samy Abbas Elbaz, Waleed Hassan Omar, Hosam Ghazy Elbanna, Mohamed Youssef, Sameh Hany Emile, et al. The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience. J Surg. 2016;4(5):114-121. doi: 10.11648/j.js.20160405.15

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  • @article{10.11648/j.js.20160405.15,
      author = {Samy Abbas Elbaz and Waleed Hassan Omar and Hosam Ghazy Elbanna and Mohamed Youssef and Sameh Hany Emile and Mohamed Farid},
      title = {The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience},
      journal = {Journal of Surgery},
      volume = {4},
      number = {5},
      pages = {114-121},
      doi = {10.11648/j.js.20160405.15},
      url = {https://doi.org/10.11648/j.js.20160405.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20160405.15},
      abstract = {Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients’ demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.},
     year = {2016}
    }
    

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    T1  - The Value of Laparoscopic Total Mesorectal Excision and Circumferential Resection Margin in the Treatment of Distal Rectal Cancer: Single Center Experience
    AU  - Samy Abbas Elbaz
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    AB  - Total mesorectal excision (TME) has emerged as a method for complete cure of rectal cancer with promising results. The present study aimed to evaluate the technical feasibility and the clinical and oncological outcomes of laparoscopic TME with abdominoperineal resection (APR) for distal rectal carcinoma. Twenty patients with distal rectal carcinoma were treated with laparoscopic APR and TME in the period of January 2012 to March 2015. Patients’ demographics, clinical symptoms, operation time, complications, pathological characteristics of the rectal tumor, and the local and distant recurrence of the tumor were recorded and analyzed. The study included 11 (55%) female and 9 (45%) male of a mean age of 46.9 ± 10.8 years. The mean distance of the tumor from the anal verge was 3.35 ± 0.9 cm. The mean operation time was 182 ± 7 minutes. Adenocarcinoma accounted for 55% of cases, whereas mucinous adenocarcinoma was detected in 40% of patients, and signet ring carcinoma in 5%. The mean circumferential resection margin (CRM) was 4.6 ±3.5 mm. The mean duration of hospital stay was 9.21± 6.9 days. Perioperative complications were recorded in seven patients (35%). Five (25%) cases were converted to open surgery. The median follow-up duration was 18 months. Local recurrence was diagnosed in two (10%) cases. Laparoscopic TME is a technically feasible procedure, yet requires adequate training and sufficient knowledge of the anatomy of the pelvis. Although all patients underwent APR and 90% of them received neoadjuvant treatment; the local recurrence was still higher than other studies which can be attributed to the pathologic characters and the stage of the tumors.
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Author Information
  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

  • General Surgery Department, Colorectal Surgery Unit, Mansoura University Hospital, Mansoura University, Mansoura City, Egypt

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