The role and place of transanal endoscopic resections in rectal cancer
The aim of the work is to improve the algorithm of intraoperative diagnosis of rectal cancer metastasis in order to optimize surgical intervention and reduce the number of intraoperative and postoperative complications. Materials and methods. 184 operated patients with rectal cancer (RC) were div...
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Zaporizhzhia State Medical and Pharmaceutical University
2023-03-01
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| Series: | Zaporožskij Medicinskij Žurnal |
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| Online Access: | http://zmj.zsmu.edu.ua/article/view/264119/269888 |
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| author | R. P. Nikitenko V. M. Zaporozhan K. O. Vorotyntseva Ye. A. Koichev |
| author_facet | R. P. Nikitenko V. M. Zaporozhan K. O. Vorotyntseva Ye. A. Koichev |
| author_sort | R. P. Nikitenko |
| collection | DOAJ |
| description | The aim of the work is to improve the algorithm of intraoperative diagnosis of rectal cancer metastasis in order to optimize surgical intervention and reduce the number of intraoperative and postoperative complications.
Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: group 1 – patients with stage I RC (T1–2N0M0), and group 2 – stage II RC (T3N0M0), who underwent intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS).
The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and late (recurrent rectal cancer) complications.
Results. The patients of group 1 had no MTS lesions of the sentinel lymph nodes, the surgical intervention was limited to transanal microsurgery due to this fact. Among the complications were the following: bleeding – 2.2 %; intraoperative perforation of the intestinal wall – 5.6 %. No purulent-septic cases, no recurrences of rectal cancer were detected.
In group 2, 36 (38.3 %) out of 94 patients had MTS detected intraoperatively in the sentinel lymph nodes which required a low anterior rectal resection with total mesorectumectomy. Among the complications was bleeding – 6.3 %. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (12.8 %) patients.
Conclusions. Performing transanal endoscopic resections in patients with stage I RC and especially stage II RC is possible only under the conditions of mandatory intraoperative staining and urgent histological examination of the sentinel lymph nodes. The extent of the surgical intervention is determined on the operating table based on urgent histological examination results. When MTS lesions of the mesorectal sentinel lymph nodes are detected, the operation should be continued with mandatory mesorectumectomy. |
| format | Article |
| id | doaj-art-e7f0e0f968ba4fecba880f9804bde7a7 |
| institution | OA Journals |
| issn | 2306-4145 2310-1210 |
| language | English |
| publishDate | 2023-03-01 |
| publisher | Zaporizhzhia State Medical and Pharmaceutical University |
| record_format | Article |
| series | Zaporožskij Medicinskij Žurnal |
| spelling | doaj-art-e7f0e0f968ba4fecba880f9804bde7a72025-08-20T02:22:15ZengZaporizhzhia State Medical and Pharmaceutical UniversityZaporožskij Medicinskij Žurnal2306-41452310-12102023-03-01251414510.14739/2310-1210.2023.1.264119The role and place of transanal endoscopic resections in rectal cancerR. P. Nikitenko0https://orcid.org/0000-0003-4214-5534V. M. Zaporozhan1https://orcid.org/0000-0002-8387-3741K. O. Vorotyntseva2https://orcid.org/0000-0003-1002-7015Ye. A. Koichev3https://orcid.org/0000-0003-0212-0578Odesa National Medical University, UkraineOdesa National Medical University, UkraineOdesa National Medical University, UkraineOdesa National Medical University, UkraineThe aim of the work is to improve the algorithm of intraoperative diagnosis of rectal cancer metastasis in order to optimize surgical intervention and reduce the number of intraoperative and postoperative complications. Materials and methods. 184 operated patients with rectal cancer (RC) were divided into 2 groups: group 1 – patients with stage I RC (T1–2N0M0), and group 2 – stage II RC (T3N0M0), who underwent intraoperative detection and examination of sentinel lymph nodes. The volume and surgical approach depended on the stage and the presence of metastases (MTS). The average period of postoperative observation was 12–60 months, taking into account early (purulent-septic complications, bleeding, intestinal perforation) and late (recurrent rectal cancer) complications. Results. The patients of group 1 had no MTS lesions of the sentinel lymph nodes, the surgical intervention was limited to transanal microsurgery due to this fact. Among the complications were the following: bleeding – 2.2 %; intraoperative perforation of the intestinal wall – 5.6 %. No purulent-septic cases, no recurrences of rectal cancer were detected. In group 2, 36 (38.3 %) out of 94 patients had MTS detected intraoperatively in the sentinel lymph nodes which required a low anterior rectal resection with total mesorectumectomy. Among the complications was bleeding – 6.3 %. No intraoperative perforations of the intestinal wall and no purulent-septic complications were detected. Recurrence of rectal cancer was detected in 12 (12.8 %) patients. Conclusions. Performing transanal endoscopic resections in patients with stage I RC and especially stage II RC is possible only under the conditions of mandatory intraoperative staining and urgent histological examination of the sentinel lymph nodes. The extent of the surgical intervention is determined on the operating table based on urgent histological examination results. When MTS lesions of the mesorectal sentinel lymph nodes are detected, the operation should be continued with mandatory mesorectumectomy.http://zmj.zsmu.edu.ua/article/view/264119/269888rectal cancersentinel lymph nodeindocyanine greentransanal endoscopic microsurgery |
| spellingShingle | R. P. Nikitenko V. M. Zaporozhan K. O. Vorotyntseva Ye. A. Koichev The role and place of transanal endoscopic resections in rectal cancer Zaporožskij Medicinskij Žurnal rectal cancer sentinel lymph node indocyanine green transanal endoscopic microsurgery |
| title | The role and place of transanal endoscopic resections in rectal cancer |
| title_full | The role and place of transanal endoscopic resections in rectal cancer |
| title_fullStr | The role and place of transanal endoscopic resections in rectal cancer |
| title_full_unstemmed | The role and place of transanal endoscopic resections in rectal cancer |
| title_short | The role and place of transanal endoscopic resections in rectal cancer |
| title_sort | role and place of transanal endoscopic resections in rectal cancer |
| topic | rectal cancer sentinel lymph node indocyanine green transanal endoscopic microsurgery |
| url | http://zmj.zsmu.edu.ua/article/view/264119/269888 |
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