OBJECTIVE: To investigate the efficacy of transanal endoscopic microsurgery (TEM) combined with imatinib for rectal gastrointestinal stromal tumors(GIST). METHODS: Clinical data of 35 patients with rectal GIST undergoing TEM at Peking Union Medical College Hospital from February 2008 to May 2017 were analyzed retrospectively. Operation details, postoperative recovery condition, and follow-up information were reviewed. The differences in clinicopathological features and perioperative parameters were compared between patients who received neoadjuvant therapy (12 patients, imatinib mesylate, oral, 400 mg daily for 6 months before surgery) and those without neoadjuvant therapy (23 patients). RESULTS: Of 35 patients, 18 were males and 17 were females with the mean age of (49.3±13.3) years. Mean tumor diameter was (1.8±1.1) cm and mean distance from lower tumor margin to anal verge was (4.0±1.8) cm. Mean operative time was (82.4±21.1) minutes and mean blood loss was (11.7±7.5) ml. No conversion to laparotomy occurred. Complete resection with negative margins was achieved in all cases. Complications were classified according to Clavien-Dindo system: 4 cases of grade I, 3 of grade II and 1 of grade IIIb. The tumor size in patients who received neoadjuvant therapy reduced from (3.1±1.2) cm to (2.6±1.2) cm, though it was still larger than the tumor size in patients without neoadjuvant therapy[(1.5±0.8) cm, P<0.01]. No significant difference in operative time was found between patients with and without neoadjuvant therapy [(76.7±24.8) minutes vs. (85.4±18.8) minutes, P>0.05]. Thirty patients (85.7%) were followed up for (50.3±36.6) months, and no local recurrence or metastasis was observed. CONCLUSIONS TEM is safe and effective in the treatment of rectal GIST. Preoperative neoadjuvant therapy is beneficial to TEM in treating larger tumors without increasing operating time. Satisfactory follow-up result is observed.
Adult ; Female ; Gastrointestinal Stromal Tumors ; drug therapy ; surgery ; Humans ; Imatinib Mesylate ; therapeutic use ; Male ; Middle Aged ; Rectal Neoplasms ; drug therapy ; surgery ; Retrospective Studies ; Transanal Endoscopic Microsurgery ; standards ; Treatment Outcome

Thanks to endoscopic assistance and the pressure effect of pelvic pneumoperitoneum, transanal total mesorectal excision (taTME) can better expose the surgical field of distal mesorectal space, and may have a prospect for the preservation of pelvic nerves and organ function. The transanal minimally invasive surgery (TAMIS) platform may decrease the injury of internal anal sphincter and protect anal function. Current data show that taTME procedure has similar results on postoperative anal function, urinary function and sexual function compared to transabdominal TME procedure. The early impaired anal function after taTME may be related to the transanal approach itself, implement of single port and the learning curve, but the anal function can improve with time. Regarding the protection of urinary and sexual function, the beginners should be familiar with the course of pelvic nerves, the anatomical landmarks and the technical points during the dissection upward, and try to avoid the injury of the pelvic plex trunk and pelvic splanchnic nerves. TaTME is different from natural orifice transluminal endoscopic surgery (NOTES), while the latter focuses on the minimally invasive principle, the former focuses on the oncological safety and nerve protection. We should combine the advantages of transanal and transabdominal approaches to achieve the final goal of surgical quality improvement and organ function preservation.
Humans ; Learning Curve ; Natural Orifice Endoscopic Surgery ; Rectal Neoplasms ; Rectum ; surgery ; Transanal Endoscopic Surgery

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.
Autonomic Pathways/surgery* ; Humans ; Proctectomy ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

Transanal total mesorectal excision (taTME) for rectal cancer is a hot spot in the field of colorectal surgery in recent years, because this technique has the advantages of clear distal margin, early separation of tumor leision, in the treatment of low rectal cancer. However, this technique is not popularized yet, and there are only a few colorectal surgeons who have enough experience. This article shares the experience of taTME in our hospital, including the details of purse string suture, spiral dissection of rectum, and the anatomic markers of anterior and posterior of rectum, conjoined longitudinal muscle and capillary of pelvic nerves locating in pelvic fascia. We sum up the crucial techniques as transanal operation, single port endoscopic technique and mucosal surgical principle (from inside to outside and from bottom to top), aiming to help colorectal surgeons to grasp the essentials of the techniques with initial cases as soon as possible, and to shorten the learning curve, so that more and more patients can benefit.
Anal Canal ; Colorectal Surgery ; Humans ; Rectal Neoplasms ; surgery ; Rectum ; Transanal Endoscopic Surgery

China has the largest group of patients with colorectal cancer in the world, but there are few international guidelines for the diagnosis and treatment of colorectal cancer from China, or evidence of high-level " evidence-based medicine" research in China. Transanal total mesorectal excision (taTME) is a new surgical procedure emerging in the field of colorectal surgery in recent years. taTME-related clinical research is almost simultaneously carried out in parallel with its clinical practice in the world. Based on the experience of Chinese TaTME Registry Collaborative and COLOR trials in colorectal surgery field, we aim to introduce how to organize and conduct COLOR III trial in China. To use the standardized clinical practice and clinical study of taTME surgery as an example, and promote it in colorectal surgery to realize the transformation to research-oriented disciplines, Chinese colorectal surgery has a long way to go.
China ; Colorectal Surgery ; Humans ; Rectal Neoplasms ; surgery ; Rectum ; Transanal Endoscopic Surgery

In recent years, transanal total mesorectal excision (taTME) has been a hot spot in the field of colorectal surgery. Compared with the traditional laparoscopic technique, taTME has potential advantages in the treatment of rectal diseases. However, the procedural safety and effectiveness of taTME need further verification. In order to ensure the safe and standardized implementation of this procedure, the European Society of Coloproctology, together with 14 international academic organizations related to colorectal surgery and minimally invasive surgery, has developed the international expert consensus guidance on indications, implementation and quality measures for taTME. This paper introduces the background of the international consensus guidance, and interprets its core contents, including the surgical indications (complex pelvic conditions, malignant and benign rectal diseases), surgical quality and outcome evaluation, structured training, and expert center. It is expected to provide reference and guidance for Chinese colorectal surgery colleagues performing taTME.
Consensus ; Humans ; Laparoscopy ; Quality Indicators, Health Care ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

Humans ; Laparoscopy ; Proctectomy ; Quality of Life ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

Transanal total mesorectal excision (taTME) is one of the hotspots in colorectal surgery in recent years. Although most studies confirm that taTME is safe and feasible, some studies still showed that the morbidity of complication and local recurrence rate of taTME were higher than traditional laparoscopic surgery. This article reviews and analyzes the short-term and long-term outcomes of taTME and the related progress of postoperative function. The results showed that there were no significant differences in the main short-term and long-term efficacy between taTME and traditional laparoscopic TME, but taTME had potential advantages in postoperative functional recovery. The results of case study after passing the learning curve suggested that taTME had better short-term and long-term efficacy. Moreover, with the maturity of taTME technology, transanal endoscopic surgery has gradually shown its advantages in the treatment of complex pelvic diseases. In the future, the application of single-port robot will further promote the development of natural orifice transluminal endoscopic colorectal surgery.
Humans ; Neoplasm Recurrence, Local ; Proctectomy ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

As a novel surgical technique, taTME has developed rapidly in recent years. TaTME inevitably attracts some skepticism on safety, efficacy, and indication. First, the controversies over taTME are mainly reflected on the safety and effectiveness of taTME. On one hand, the increase of surgical complications, such as urethral injury, CO2 embolism, anastomotic leakage and pelvic infection, has raised concerns about the safety of taTME. Second, the poor quality of taTME specimens, the increased local recurrence rate and the impaired anal function after taTME, also make people question the effectiveness of taTME. Third, there are more or less controversies in the selection of taTME cases, surgical procedures and cost-effectiveness. However, it can not be denied that taTME has a promising future in view of both surgical theory and clinical practice. Furthermore, taTME is a relatively safe and effective supplementary surgical procedure, especially for patients with low rectal cancer. We should attach more importance to structured training for beginners and conduct high-quality clinical studies in the future development of taTME in China, so as to ensure the safe implementation of taTME and obtain high-level evidence-based medicine evidence, and then standardize the clinical practice of taTME.
Humans ; Neoplasm Recurrence, Local ; Proctectomy ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery

Humans ; Laparoscopy ; Proctectomy ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Transanal Endoscopic Surgery