Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2017; 23(31): 5798-5808
Published online Aug 21, 2017. doi: 10.3748/wjg.v23.i31.5798
Simple instruments facilitating achievement of transanal total mesorectal excision in male patients
Chang Xu, Hua-Yu Song, Shao-Liang Han, Shi-Chang Ni, Hu-Xiang Zhang, Chun-Gen Xing
Chang Xu, Chun-Gen Xing, Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Chang Xu, Hua-Yu Song, Shao-Liang Han, Shi-Chang Ni, Department of Colorectal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Hu-Xiang Zhang, Department of Pathology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Xu C, Song HY and Xing CG designed the research; Xu C, Song HY, Ni SC and Zhang HX performed the research; Xu C and Han SL analyzed the data; Xu C, Han SL and Xing CG wrote the paper.
Supported by (in part) Wenzhou Science and Technology Project, No. Y20160044; Suzhou Key Medical Center, No. LCZX201505; Soochow Development of Science and Technology Projects, No. SZS201618; Chinese Natural Science Foundation, No. 81672970; and Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project, No. XKQ2015007.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chun-Gen Xing, MD, Professor, Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China. xingcg@suda.edu.cn
Telephone: +86-512-68284303 Fax: +86-512-68284303
Received: February 7, 2017
Peer-review started: February 9, 2017
First decision: May 12, 2017
Revised: June 18, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: August 21, 2017
Processing time: 192 Days and 13.2 Hours
Abstract
AIM

To assess the efficacy of a modified approach with transanal total mesorectal excision (taTME) using simple customized instruments in male patients with low rectal cancer.

METHODS

A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor (tumor diameter ≥ 40 mm). Forty-one patients (group A) underwent a classical approach of transabdominal total mesorectal excision (TME) and transanal intersphincteric resection (ISR), and the other 74 patients (group B) underwent a modified approach with transabdominal TME, transanal ISR, and taTME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform taTME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated.

RESULTS

All 115 patients had successful sphincter preservation. The operative time in group B (240 min, range: 160-330 min) was significantly shorter than that in group A (280 min, range: 200-360 min; P = 0.000). Compared with group A, more complete distal mesorectum and total mesorectum were achieved in group B (100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo follow-up, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant (5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130).

CONCLUSION

Retrograde taTME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

Keywords: Rectal neoplasm; Total mesorectal excision; Transanal approach; Intersphincteric resection; Long-term outcome; Local recurrence

Core tip: Distal mesorectal excision is difficult in male patients with low rectal cancers, especially with a bulky tumor. We explored the application of simple instruments including modified retractors and an anal dilator with a papilionaceous fixture to perform transanal total mesorectal excision (taTME) in male patients with low rectal cancer. Our results showed that the modified approach with taTME achieved a shorter operative time and better quality of mesorectal excision as compared with the classical approach. This procedure may be an effective and economical alternative for taTME when a giant tumor is encountered in patients with low rectal cancer.