Techniques in Total Mesorectal Excision Surgery

Abstract

Advances in the surgical management of rectal cancer have placed the quality of total mesorectal excision (TME) as the major predictor in overall survival. A standardized TME technique along with quality increases the percentage of patients undergoing a complete TME. Quality measurements of TME will place increasing demands on surgeons maintaining competence with present and future techniques. These efforts will improve the outcome of the rectal cancer patients.

Keywords

rectal cancer - total mesorectal excision - surgical technique

• References

• 1 Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon (1908). CA Cancer J Clin 1971; 21 (6) 361-364
• 2 Dixon CF. Anterior resection for malignant lesions of the upper part of the rectum and lower part of the sigmoid. Ann Surg 1948; 128 (3) 425-442
• 3 Goligher JC, Dukes CE, Bussey HJ. Local recurrences after sphincter saving excisions for carcinoma of the rectum and rectosigmoid. Br J Surg 1951; 39 (155) 199-211
• 4 Fain SN, Patin CS, Morgenstern L. Use of a mechanical suturing apparatus in low colorectal anastomosis. Arch Surg 1975; 110 (9) 1079-1082
• 5 Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 1983; 198 (2) 159-163
• 6 Kuvshinoff B, Maghfoor I, Miedema B , et al. Distal margin requirements after preoperative chemoradiotherapy for distal rectal carcinomas: are < or = 1 cm distal margins sufficient?. Ann Surg Oncol 2001; 8 (2) 163-169
• 7 Park IJ, Kim JC. Adequate length of the distal resection margin in rectal cancer: from the oncological point of view. J Gastrointest Surg 2010; 14 (8) 1331-1337
• 8 Tjandra JJ, Kilkenny JW, Buie WD , et al; Standards Practice Task Force; American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 2005; 48 (3) 411-423
• 9 Quirke P. Training and quality assurance for rectal cancer: 20 years of data is enough. Lancet Oncol 2003; 4 (11) 695-702
• 10 Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 1986; 2 (8514) 996-999
• 11 Adam IJ, Mohamdee MO, Martin IG , et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet 1994; 344 (8924) 707-711
• 12 Heald RJ. A new approach to rectal cancer. Br J Hosp Med 1979; 22 (3) 277-281
• 13 Heald RJ. The ‘Holy Plane’ of rectal surgery. J R Soc Med 1988; 81 (9) 503-508
• 14 Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?. Br J Surg 1982; 69 (10) 613-616
• 15 Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D. Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene?. Gut 2008; 57 (12) 1690-1697
• 16 Abbas MA, Chang GJ, Read TE , et al; Consortium for Optimizing Surgical Treatment of Rectal Cancer. Optimizing rectal cancer management: analysis of current evidence. Dis Colon Rectum 2014; 57 (2) 252-259
• 17 Scott N, Jackson P, al-Jaberi T, Dixon MF, Quirke P, Finan PJ. Total mesorectal excision and local recurrence: a study of tumour spread in the mesorectum distal to rectal cancer. Br J Surg 1995; 82 (8) 1031-1033
• 18 Maurer CA, Renzulli P, Kull C , et al. The impact of the introduction of total mesorectal excision on local recurrence rate and survival in rectal cancer: long-term results. Ann Surg Oncol 2011; 18 (7) 1899-1906
• 19 Martling AL, Holm T, Rutqvist LE, Moran BJ, Heald RJ, Cedemark B. Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project. Lancet 2000; 356 (9224) 93-96
• 20 Hainsworth PJ, Egan MJ, Cunliffe WJ. Evaluation of a policy of total mesorectal excision for rectal and rectosigmoid cancers. Br J Surg 1997; 84 (5) 652-656
• 21 Buunen M, Bonjer HJ, Hop WC , et al; Color II Study Group. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer. Dan Med Bull 2009; 56 (2) 89-91
• 22 Kitano S, Inomata M, Sato A, Yoshimura K, Moriya Y ; Japan Clinical Oncology Group Study. Randomized controlled trial to evaluate laparoscopic surgery for colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 2005; 35 (8) 475-477
• 23 Guillou PJ, Quirke P, Thorpe H , et al. MRC CLASSIC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicentre, randomised, controlled trial. Lancet 2005; 365: 1718-1726
• 24 Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350 (20) 2050-2059
• 25 Baek JH, McKenzie S, Garcia-Aguilar J, Pigazzi A. Oncologic outcomes of robotic-assisted total mesorectal excision for the treatment of rectal cancer. Ann Surg 2010; 251 (5) 882-886
• 26 deSouza AL, Prasad LM, Ricci J , et al. A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma. Dis Colon Rectum 2011; 54 (3) 275-282
• 27 Trastulli S, Farinella E, Cirocchi R , et al. Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis 2012; 14 (4) e134-e156
• 28 Nogueras JJ. Open low anterior resection. In: Wexner SD, Fleshman JW, Fischer JE, , eds. Master Techniques in General Surgery: Colon and Rectal Surgery: Abdominal Operations. Philadelphia, PA: Lippincott Williams & Wilkins; 2012: 127-131
• 29 Monson JR, Weiser MR, Buie WD , et al; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 2013; 56 (5) 535-550
• 30 Lange MM, Buunen M, van de Velde CJH, Lange JF. Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 2008; 51 (7) 1139-1145
• 31 Shin J, Lee SW. Laparoscopic complications. In: Steele SR, Maykel JA, Champagne BJ, Orangio GR, , eds. Complexities in Colorectal Surgery. New York: Springer; 2014
• 32 Hiranyakas A, Da Silva G, Denoya P, Shawki S, Wexner SD. Colorectal anastomotic stricture: is it associated with inadequate colonic mobilization?. Tech Coloproctol 2013; 17 (4) 371-375
• 33 Efron JE, Vargas HD. The morbidly obese patient. In: Steele SR, Maykel JA, Champagne BJ, Orangio GR, , eds. Complexities in Colorectal Surgery. New York: Springer; 2014
• 34 Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81 (8) 1224-1226
• 35 Quirke P, Steele R, Monson J , et al. MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group. Effect of the plane of surgery achieved on local recurrence in patients with operable cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 2009; 373: 821-828
• 36 Quirke P, Dixon MF. The prediction of local recurrence in rectal adenocarcinoma by histopathological examination. Int J Colorectal Dis 1988; 3 (2) 127-131
• 37 Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH ; Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 2002; 20 (7) 1729-1734
• 38 Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer?. J Clin Oncol 2008; 26 (2) 303-312
• 39 Jass JR, O'Brien MJ, Riddell RH, Snover DC ; Association of Directors of Anatomic and Surgical Pathology. Recommendations for the reporting of surgically resected specimens of colorectal carcinoma. Hum Pathol 2007; 38 (4) 537-545
• 40 Fleshman J. American College of Surgeons Oncology Group (ACOSOG)-Z6051. A Phase III prospective randomized trial comparing laparoscopic-assisted resection versus open resection for rectal cancer. Available at: http://clinicaltrials.gov/ct2/show/NCT00726622 . Accessed August 17, 2009
• 41 Damle RN, Macomber CW, Flahive JM , et al. Surgeon volume and elective resection for colon cancer: an analysis of outcomes and use of laparoscopy. J Am Coll Surg 2014; 218 (6) 1223-1230
• 42 Sammour T, Kahokehr A, Srinivasa S, Bissett IP, Hill AG. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 2011; 253 (1) 35-43
• 43 Heneghan HM, Martin ST, Kiran RP , et al. Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg 2013; 17 (3) 548-554
• 44 Bailey MB, Davenport DL, Vargas HD, Evers BM, McKenzie SP. Longer operative time: deterioration of clinical outcomes of laparoscopic colectomy versus open colectomy. Dis Colon Rectum 2014; 57 (5) 616-622
• 45 Jayne DG, Guillou PJ, Thorpe H , et al; UK MRC CLASICC Trial Group. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 2007; 25 (21) 3061-3068
• 46 Marcello PW, Fleshman JW, Milsom JW , et al. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 2008; 51 (6) 818-826 , discussion 826–828
• 47 Palaniappa NC, Telem DA, Ranasinghe NE, Divino CM. Incidence of iatrogenic ureteral injury after laparoscopic colectomy. Arch Surg 2012; 147 (3) 267-271
• 48 Jafari MD, Wexner SD, Martz JE, McLemore EC, Margolin DA, Sherwinter DA, Lee SW, Senagore AJ, Phelan MJ, Stamos MJ. Perfusion Assessment in Laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 2015; 220 (1) 82-92.e1
• 49 Fleshman JW. Laparoscopic low anterior resection. In: Fleshman JW, Birbaum EH, Hunt SR, , et al., eds. Atlas of Surgical Techniques for the Colon, Rectum, and Anus. Philadelphia, PA: Elsevier Saunders; 2013
• 50 Ding J, Liao GQ, Xia Y , et al. Medial versus lateral approach in laparoscopic colorectal resection: a systematic review and meta-analysis. World J Surg 2013; 37 (4) 863-872
• 51 Halabi WJ, Jafari MD, Nguyen VQ , et al. Ureteral injuries in colorectal surgery: an analysis of trends, outcomes, and risk factors over a 10-year period in the United States. Dis Colon Rectum 2014; 57 (2) 179-186
• 52 Delaney CP, Pokala N, Senagore AJ , et al. Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum 2005; 48 (5) 975-981
• 53 Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J. The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg 2005; 241: 69-76 2013;
• 54 Makino T, Shukla PJ, Rubino F, Milsom JW. The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 2012; 255 (2) 228-236
• 55 Lin AY. Open low anterior resection of rectum. In: Fleshman JW, Birbaum EH, Hunt SR, , et al., eds. Atlas of Surgical Techniques for the Colon, Rectum, and Anus. Philadelphia PA: Elsevier Saunders; 2013