Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series
Abstract Background Surgery for perforated rectal cancer is technically difficult because of paralytic dilatation due to generalized fecal peritonitis, the presence of a bulky tumor, and fecal retention due to obstruction. Transanal total mesorectal excision (TaTME) is the latest minimally invasive...
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Japan Surgical Society
2022-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01480-z |
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| author | Hiroya Enomoto Katsuhito Suwa Nana Takeuchi Yuhei Tsukazaki Takuro Ushigome Tomoyoshi Okamoto Ken Eto |
| author_facet | Hiroya Enomoto Katsuhito Suwa Nana Takeuchi Yuhei Tsukazaki Takuro Ushigome Tomoyoshi Okamoto Ken Eto |
| author_sort | Hiroya Enomoto |
| collection | DOAJ |
| description | Abstract Background Surgery for perforated rectal cancer is technically difficult because of paralytic dilatation due to generalized fecal peritonitis, the presence of a bulky tumor, and fecal retention due to obstruction. Transanal total mesorectal excision (TaTME) is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. It can provide a good surgical field linearly from the perineal side and reduce manipulations from the intraabdominal side. Here, we present two cases of emergency TaTME performed for perforated rectal cancer. Case presentation The patients were a 38-year-old female and a 75-year-old male. They were diagnosed with perforated rectal cancer and were in a state of septic shock. Emergency Hartmann’s procedure was performed in both cases. Intraoperative findings showed fecal contamination of the entire abdomen and dilated intestines and bulky tumors with perforation. The female patient had multiple uterine fibroids, and the male patient had an enlarged prostate. For both patients, dissection of the mesorectum to the anal side of the tumor and transection of the rectum on the anal side of the tumor via a linear stapler were considered difficult because of the insufficient surgical field of view into the pelvis. Therefore, a two-team approach with TaTME was adopted. En bloc resection of the rectum was completed by collaboration of the abdominal team and the transanal team, and the autonomic nerves were successfully preserved. Finally, the specimens were resected, and the anal edge of the rectum was closed with a purse-string suture by the transanal team. Although these two cases were emergency surgeries in difficult situations, the cancer lesions were successfully and safely removed without involvement of the resection margin. Conclusions This is the first report of emergency TaTME. Although these cases were emergency operations in a situation where it was difficult to pursue radical resection—and often times in these situations, the operation may end with only stoma creation—the specimens were safely resected. Emergency TaTME is a useful procedure for treatment of perforated rectal cancer. |
| format | Article |
| id | doaj-art-1ba9055788ea4cb39ada4cf77f786746 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-1ba9055788ea4cb39ada4cf77f7867462025-08-20T03:15:16ZengJapan Surgical SocietySurgical Case Reports2198-77932022-06-01811610.1186/s40792-022-01480-zEmergency transanal total mesorectal excision for perforated rectal cancer: a two-case seriesHiroya Enomoto0Katsuhito Suwa1Nana Takeuchi2Yuhei Tsukazaki3Takuro Ushigome4Tomoyoshi Okamoto5Ken Eto6Department of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University HospitalAbstract Background Surgery for perforated rectal cancer is technically difficult because of paralytic dilatation due to generalized fecal peritonitis, the presence of a bulky tumor, and fecal retention due to obstruction. Transanal total mesorectal excision (TaTME) is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. It can provide a good surgical field linearly from the perineal side and reduce manipulations from the intraabdominal side. Here, we present two cases of emergency TaTME performed for perforated rectal cancer. Case presentation The patients were a 38-year-old female and a 75-year-old male. They were diagnosed with perforated rectal cancer and were in a state of septic shock. Emergency Hartmann’s procedure was performed in both cases. Intraoperative findings showed fecal contamination of the entire abdomen and dilated intestines and bulky tumors with perforation. The female patient had multiple uterine fibroids, and the male patient had an enlarged prostate. For both patients, dissection of the mesorectum to the anal side of the tumor and transection of the rectum on the anal side of the tumor via a linear stapler were considered difficult because of the insufficient surgical field of view into the pelvis. Therefore, a two-team approach with TaTME was adopted. En bloc resection of the rectum was completed by collaboration of the abdominal team and the transanal team, and the autonomic nerves were successfully preserved. Finally, the specimens were resected, and the anal edge of the rectum was closed with a purse-string suture by the transanal team. Although these two cases were emergency surgeries in difficult situations, the cancer lesions were successfully and safely removed without involvement of the resection margin. Conclusions This is the first report of emergency TaTME. Although these cases were emergency operations in a situation where it was difficult to pursue radical resection—and often times in these situations, the operation may end with only stoma creation—the specimens were safely resected. Emergency TaTME is a useful procedure for treatment of perforated rectal cancer.https://doi.org/10.1186/s40792-022-01480-zPerforated colorectal cancerTaTMERectal cancer |
| spellingShingle | Hiroya Enomoto Katsuhito Suwa Nana Takeuchi Yuhei Tsukazaki Takuro Ushigome Tomoyoshi Okamoto Ken Eto Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series Surgical Case Reports Perforated colorectal cancer TaTME Rectal cancer |
| title | Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series |
| title_full | Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series |
| title_fullStr | Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series |
| title_full_unstemmed | Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series |
| title_short | Emergency transanal total mesorectal excision for perforated rectal cancer: a two-case series |
| title_sort | emergency transanal total mesorectal excision for perforated rectal cancer a two case series |
| topic | Perforated colorectal cancer TaTME Rectal cancer |
| url | https://doi.org/10.1186/s40792-022-01480-z |
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