Application value of Da Vinci robotic transanal minimally invasive surgery for local resection of rectal neoplasms / 中华消化外科杂志

Objective:To investigate the application value of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for local resection of rectal neoplasms.Methods:The retros-pective and descriptive study was conducted. The clinicopathological data of 7 rectal neoplasms patients undergoing R-TAMIS in Daping Hospital of Army Medical University from June 2017 to March 2021 were collected. There were 3 males and 4 females, aged (60±7)years. Observation indicators: (1) intraoperative situations; (2) postoperative recovery; (3) postoperative histopatholo-gical examinations; (4) follow-up. Follow-up was conducted using telephone interview or outpatient examination to detect readmission of patients within postoperative 30 days, tumor recurrence and metastasis and survival of patients. Follow-up was performed at postoperative 1, 3, 6 months and once every 6 months thereafter up to April 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All the 7 patients underwent R-TAMIS successfully without conversion to laparotomy or laparoscopic surgery. Of the 7 patients, 2 cases underwent full-thickness rectal resection and 5 cases underwent submucosal dissection of tumor. The rectal wounds were not sutured in 2 cases because of large lesions, and the rectal wounds were sutured with synthetic sutures in 5 cases after resection of lesions. Transanal drainage tube was placed in 2 cases and not in 5 cases. The volume of intra-operative blood loss of the 7 patients was 15(range, 2?50)mL. The total operation time of the 7 patients was (91.4±18.4)minutes, including (19.1±2.3)minutes for transanal platform placement and Da Vinci robotic surgical system installation, and (72.3±16.6)minutes for operation. There was no intraoperative complication such as urethral injury. (2) Postoperative recovery. All the 7 patients started water drinking and out-of-bed activities at postoperative day 1 and liquid food intake at postoperative day 2. The time to postoperative first flatus of the 7 patients was 1(range, 1?3)days. The two cases with transanal drainage underwent removing of transanal drainage at postoperative day 2. There was no postoperative complication and the duration of postoperative hospital stay of the 7 patients was 3(range, 3?9)days. (3) Postoperative histopathological examinations. Of the 7 patients, 3 cases had villous adenoma, 2 cases had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor invasion into submucosa (stage SM1), 1 case had villous adenoma combined with high grade intraepithelial neoplasia, local canceration and tumor localized in the inner mucosa (stage Tis) and 1 case had moderately differentiated adeno-carcinoma with tumor invasion into superficial muscle layer (stage T2). All the 7 patients had negative surgical margins with none of tumor cell remained in the base. (4) Follow-up. All the 7 patients were followed up for 18(range, 1?42)months. One of the 7 patients showed rectal adenocarcinoma with tumor invasion into superficial muscle layer by the postoperative histopathological examina-tion and was recommended for remedial radical surgery. The patient refused further surgery and underwent 3 courses of oral capecitabine chemotherapy. The other 6 patients did not receive postoperative chemotherapy. None of 7 patients underwent readmission within postoperative 30 days, and no patient had tumor local recurrence, distant metastasis or death during the follow-up.Conclusion:R-TAMIS for local resection of rectal neoplasms is safe and feasible for patients with rectal adenoma and early rectal cancer, with reliable short-term efficacy and short-term oncological efficacy.

Abordaje microquirúrgico transanal. Experiencia inicial. Indicaciones y resultados / Transanal microsurgical approach. Initial experience. Indications and results

Introducción: El tratamiento quirúrgico de las afecciones del recto bajo se encuentra en permanente revisión intentando mantener una adecuada función de continencia y urogenital. Una opción reciente es el abordaje microquirúrgico transanal. El objetivo del trabajo es evaluar una serie de pacientes tratados mediante dicho abordaje, analizando indicaciones, resultados inmediatos y alejados. Material y método: Se seleccionaron 41 pacientes operados en el período comprendido entre febrero de 2009 y febrero de 2015. Resultados: En 41 pacientes, las afecciones tratadas fueron: pólipos, 22; cáncer de recto, 14; estenosis de anastomosis, 2; absceso retrorrectal, 1; endometriosis, 1; poliposis adenomatosa familiar, 1. Los pacientes con pólipos llegaron a consulta: por primera vez, 15; recidivados, 4; segunda recidiva, 2; tercera recidiva, 1. Los procedimientos realizados fueron: resección local, 29; microcirugía transanal transabdominal (TATA), 6; dilatación de estenosis, 4; biopsia transrectal, 3; drenaje de absceso retrorrectal, 1; control de hemorragia, 1; colocación de stent, 1. En cáncer de recto: resección local, 7; biopsia transrectal, 2; TATA, 4; colocación de stent, 1. El tiempo operatorio promedio fue 48,6 minutos, y la estadía hospitalaria promedio 2,21 días. De los 29 pacientes en quienes se realizó resección local, fueron controlados 25 durante un período de 6 a 72 meses. Se complicaron 11 pacientes, sin mortalidad ni recidivas locales. Conclusiones: Este abordaje permite tratar lesiones del recto y último segmento del colon sigmoides. Otorga mejor visión permitiendo una disección más exacta, mejorando resultados postoperatorios inmediatos y alejados en patología benigna y maligna, minimizando la posibilidad de recidivas. (AU)

Introduction: The surgical treatment of conditions located at the low rectum is in constant review, triying to maintain proper urogenital and continence function. One of the most recent options is the transanal microsurgical. The aim of this paper is to analyze a series of patients treated with this approach, its indications, immediate and long term results. Material and Methods: 41 patients were analyzed retrospectively in the period between February 2009 and February 2015. Results: In these patients, treated conditions were polyps: 22; rectal cancer: 14; anastomotic stricture: 2; retrorectal abscess: 1; endometriosis: 1; familial adenomatous polyposis: 1. Patients affected with polyps reached the first consultation in 15 opportunities; 4 on first recurrence; 2 with second recurrence; 1 with third recurrence. The procedures were 29 local resections; 6 transanal transabdominal resections (TATA); 4 dilations of stenosis; 3 transrectal biopsies; 1 retrorectal abscess drainage; 1 hemorrhage control; 1 stent placement. In rectal cancer were: 7 local resection; 2 transrectal biopsies; 4 TATA; 1 stent placement. Mean operative time was 48.6 minutes and mean hospital stay was 2.21 days. Of the 29 patients in whom local resection was performed, 25 were controlled for a period of 6 to 72 months. 11 patients were complicated; no deaths or local recurrences were registered. Conclusions: This approach allows to treat lesions located throughout the rectum and the last segment of sigmoid colon. A better insight is obtained allowing a more accurate dissection, thus improving the immediate and remote postoperative results and minimizes the possibility of recurrence, particularly when it comes to benign conditions. (AU)

A comparative study on local resection of rectal adenomatous polypus / 中华消化内镜杂志

Objective To compare the therapeutic effects of endoscopy,TEM,and transanal local resection in rectal adenomatous polyps.Methods Data of 195 patients with rectal adenomatous polypus,who underwent either endoscopic resection (EMR,ESD and conventional endoscopic resection,n =65),TEM (n =65) or transanal local resection (n =65) in the past two years (2009-2011) were retrospectively collected and analyzed.Results Distance from lesion to anus in endoscopic group was significantly longer than that in transanal group (P ＜ 0.05).Bleeding volume during the procedure in transanal group was significantly larger than that in endoscopic group (P ＜ 0.05).The operation time and hospitalization time in endoscopic group were significantly shorter than those in TEM group and transanal group (P ＜ 0.01).The total cost in endoscopic group was significantly lower than that in other 2 groups (P ＜ 0.01).Conclusion Endoscopic resection is a safe and effective therapy for rectal adenomatous polypus.

Surgery of gastrointestinal stromal tumor of the duodenum / 中华普通外科杂志

Objective To evaluate the results of surgical treatment for duodenal gastrointestinal stromal tumor (GIST).Methods Between January 2000 and January 2013,33 patients underwent surgical resection of duodenal GIST in Peking University Cancer Hospital,including local resection and pancreatoduodenectomy.Clinical data,surgical outcome and prognosis were reviewed.Results The median survival time is 94 months (range:55-132 months).The 1,3,5-year survival rates are 97％,89％ and 80％,respectively.The 5 year survival rate of patients after pancreatoduodenectomy and local resection is 78％ and 83％,respectively (P =0.091).It shows that tumor size and mitotic count and Fletcher classification influence overall survival.Conclusions When fulfiling proper safe margins,local resection is a reliable and curative option for most duodenal GISTs.

Resección de lesión neoplásica rectal mediante cirugía transanal mínimamente invasiva-técnica de TAMIS / Rectal neoplasm lesion resected by Transanal Minimally Invasive Surgery – TAMIS technique

We present a clinical case with a stage T1 rectal neoplasm lesion; resection was performed with transanal minimally invasive surgery-TAMIS procedure without complications. Anatomical pathology results showed invasion of the muscular layer, i.e. stage T2. The TAMIS technique, recently described by the coloproctology group of Orlando Hospital (USA), consists of using a single port device to generate a pneumorectum and resect the rectal lesion by means of regular laparoscopic tools. It has low morbidity and has gained general acceptance basically because the use of standard laparoscopic instrumentation, which reduces costs, allows one-block resections, without fragmentation of the surgical specimen and the learning curve not that long. The indication of local resection in cases of rectal cancer is still for T1 lesions, without nodal involvement and without histological factors leading to poor prognosis. Local relapse in these cases is acceptable and conservation of the rectum ensures good life quality for patients. Incorrect staging once the sample has been analyzed is indication of radical surgery and does not affect the prognosis.

Se presenta un caso clínico de una lesión neoplásica rectal etapificada como T1 la cual fue resecada con cirugía transanal mínimamente invasiva (transanal minimally invasive surgery-TAMIS) sin complicaciones. La anatomía patológica evidenció invasión hasta la túnica muscular, es decir T2. La técnica TAMIS, descrita recientemente por el grupo de coloproctología del Hospital de Orlando (EE.UU.), consiste en utilizar un dispositivo de puerto único para generar un neumorrecto y resecar la lesión rectal mediante instrumentos de laparoscopía tradicional. Tiene baja morbilidad y ha ganado aceptación principalmente por utilizar instrumental laparoscópico estándar, lo que disminuye el costo, permite resecciones transmurales, en bloque, sin fragmentar la pieza operatoria y su curva de aprendizaje no es larga. La indicación de resección local en cáncer de recto sigue siendo lesiones T1, sin compromiso nodal y sin factores de mal pronóstico histológico. La recidiva local en estos casos es aceptable y la conservación del recto permite una buena calidad de vida de los pacientes. La incorrecta etapificación una vez analizada la pieza operatoria es indicación de cirugía radical y no afecta el pronóstico.

Strategies of surgical approaches of local resection for mid-lower rectal tumors and pelvic floor neoplasia / 国际外科学杂志

Objective To investigate the strategies of surgical approaches,indications and surgical techniques of local resection for mid-lower rectal tumors and pelvic floor neoplasia.Methods Clinical data of 122 patients underwent local resection for mid-lower rectal tumors pelvic floor neoplasia between July 2004 and July 2008 were analyzed retrospectively.Results Transanal,transsacral,transsphincteric local resection was respectively performed in 45,and 32,and 45 patients.Pathological examination proved that benign tumors were account for 81 cases,pelvic floor neoplasia 16 cases,malignant tumors 25 cases.The masses were 5.6 cm(0 to 12 cm) apart from the anal border,and the mean tumors' diameter was 4.2 cm (0.5 to 11 cm).No case was diagnosed with positive margins upon final pathology of resected specimens.The rate of postoperative complications of transanal,transsacral,transsphincteric approaches was 8.9％ (4/45),18.8％ (6/32),20.0％ (9/45),respectively.The recurrence of transanal,transsacral,transsphincteric approaches was 6.7％ (3/45),9.4％ (3/32),4.4％ (2/45),respectively.Conclusions The three approaches for patients suffering from mid-lower rectal tumors and pelvic floor neoplasia have respectively advantages.Transsphincteric approach is the most useful methods,but with more postoperative complications,so it need more surgical techniques.

Local resection of duodenal papillary neoplasms / 中华消化外科杂志

Local resection of duodenal papillary neoplasm has the advantages of small trauma,few complications and retaining the normal function of digestive tract.While this surgical procedure is not widely applied because of high demand of surgical techniques,difficulty in the management of complications and its efficacy still needs the verification of evidence based medicine.From January 2000 to June 2012,4 patients received local resection of duodenal papillary neoplasm at the Renji Hospital of Shanghai Jiaotong University.All patients were confirmed as with duodenal papillary neoplasm by endoscopic retrograde cholangiopancreatography,and the diameters of the tumors were under 1 cm.The results of duodenal papillary biopsy showed that 3 cases were with hyperplasia and 1 case with adenocarcinoma.Lymph node metastasis or distal metastasis was excluded by computed tomography and magnetic resonance imaging preoperatively.The results of postoperative pathological examination confirmed that 1 case of duodenal papillary adenoma and 3 cases of duodenal papillary adenocarcinoma were with negative margin and no metastasis in the hepatoduodenal ligament was detected.There was no complications except 1 case of pancreatic leakage.There was no recurrence during a follow-up period of 3-24 months.Strictly abiding the indications and technical manual of local resection of duodenal papillary neoplasm is a key point to acquire good clinical effect.

Clinicopathological features of ampullary cancer and its diagnosis and treatment / 中华消化外科杂志

Objective To summarize the clinicopathological features of ampullary cancer,and investigate the diagnosis and treatment strategy for ampullary cancer.Methods The clinical data of 187 patients with ampullary cancer who were admitted to the Peking Union Hospital from January 2000 to December 2010 were retrospectively analyzed.According to different surgical procedures applied,patients were divided into pancreaticeduodenectomy (PD) group (162 patients) and local resection group (25 patients).Survival curve was drawn by using Kaplan-Meier method,and the difference in survival rate between the 2 groups was compared by using Log-rank test.All data were analyzed by using t test or chi-square test.Results The positive diagnostic rates of B-ultrasound,computed tomography (CT),magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP) were 9.3％ ( 15/161 ),43.9％ (65/148),21.3％ (19/89) and 83.9％ ( 135/161 ),respectively.There were 87 patients with well differentiated adenocarcinoma,64 with moderate differentiated adenocarcinoma,27 with low differentiated adenocarcinoma and 9 with tubular canceration.There were no significant differences in survival rate between patients with ampullary cancer in T1 or T2 stage who received PD or local resection ( x2 =3.163,P ＞0.05).The prognosis of patients with ampullary cancer in T3 or T4 stage who received PD were superior to those who received local resection ( x2 =6.309,P ＜ 0.05 ).Conclusions Most of the ampullary cancer is well differentiated adenocarcinoma,and ERCP has a higher diagnostic rate than B-ultrasound,CT and MRI.Local resection is an ideal treatment for patients with ampullary cancer in T1 or T2 stage,while for patients with ampullary cancer in T3 or T4 stage,PD is the first choice of treatment.

Factors about the feasibility of local excision of low rectal cancer / 肿瘤研究与临床

Objective To investigate the prognosis of local resection in patients with low rectal cancer, and assess surgical indications for this procedure. Methods One hundred and twenty-four patients with low rectal cancer from Jan 1975 to Dec 2006 were analyzed, the clinicopathologic features and surgical, outcome were examined as prognostic factors. Survival rate was estimated by Kaplan-Meier method and compared by Log-Rank test, prognostic factors were analyzed by multivariate COX proportional hazards model. Results The 5-year survival rate of 124 patients underwent local resection was 90.7 %(97/107), there were 4.8 %(6/124) patients with complications and 15.3 %(19/24) ones with local recurrence.The infiltration, vascular invasion, the size of tumor and the histological grade were significant prognostic factors of overall survival, but gender, age, the tumor site and the macroscopic type were not. Multivariate analysis indicated that the tumor infiltration were independent poor prognostic factor. Conclusion Local resection is suitable for Tis and T1 low rectal cancer, and those with high local recurrence factors should undergo radical resection. Strict follow-up and adjuvant therapy is necessary for local excision.

Efficacy of transanal local resection for early low rectal cancer / 中华消化外科杂志

Objective To evaluate the efficacy of transanal local resection for early low rectal cancer. Methods The clinical data of 72 patients with early low rectal cancer who had been admitted to Union Hospital of Fujian Medical University from January 1997 to April 2009 were retrospectively analyzed. Patients were divided into 2 groups, and they received transanal local resection (group A, n = 31) and radical resection (group B, n =41), respectively. Postoperative local recurrence and distal metastasis were analyzed by Fisher exact test, the survival was analyzed by life table method. The difference in survival between the 2 groups was analyzed by Wilcoxon test. Results Three patients were found to have surgical complications in group B, while no complication was detected in group A. The local recurrence was 6% (2/31) in group A and 0 (0/41) in group B (P < 0.05); the distal metastasis was 6% (2/31) in group A and 2% (1/41) in group B, with no significance difference between the 2 groups (χ~2 =0. 062, P >0.05). The 3- and 5-year survival rates were 93%, 87% in group A, and 95%, 91% in group B, with no significant difference between the 2 groups (χ~2 =0.099, 0.144, P >0.05). Conclusions The prognosis of patients with early low rectal cancer who received transanal local resection is similar to those who received radical resection. Transanal local resection is safe and feasible when the indications are strictly followed.

Minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA:a report of 15 cases / 中国基层医药

Objective To evaluate the curative effect and superiority of minimally invasive transanal surgery in the treatment of cancerate rectal adenoma and early rectal cancer by using CUSA.Method Local resection was clone in 15 patients with cancerate rectal adenoma or early rectal cancer,the tumours were excised intactly by 5 mm CUSA(submucosal or superficial muscularis),the incisions were closed by continuous suture in the lumen.Results All of the tumours were excised intactly,the incisal edges and funduses were all negative.The operation time was 30～180 min,average:60 min,the amount of bleeding during operation was 0～30 ml,average:10 ml.Complications:temporary fecal incontinence in 2 cases,acute urinary retention in 1 case.Pathology after operation:villous adenoma accompanied by high grade intra epithelial neoplasia in 8 cases,mixed adenoma in 2 cases,intra-mucosal carcinoma in 5 cases.15cases were followed up 4～48 months,averge 18 months,no tumour recur in original place.Conclusion Minimally invasive transanal surgery by CUSA is a safe and effective operation in the treatment of cancerate rectal adenoma and early rectal cancer.It can keep the anus and improve the quality of life.

Local Resection for Treatment of Early Colorectal Cancer

PURPOSE: Early colorectal cancer is defined as invasive tumor, limited to the mucosa or submucosa. The incidence of early colorectal cancer detection has been increased due to well designed screening technology and development of colonoscopy. The novel treatment of early colorectal cancer is still not settled despite of this advancement. We performed retrospective study about outcomes of colorectal cancer after radical resection or local resection. METHODS: Sixty two patients, diagnosed as early colorectal cancers by pathology, were selected for this case study. The hospital records were reviewed retrospectively and the following was found: Twenty four patients received local resection such as colonoscopic polypectomy or local resection of colon. Remaining thirty-eight patients received radical resection. The clinicopathologic features of two groups were analyzed statically and survival rate was compared. RESULTS: The clinical features were similar between two groups including sex, age, stage, tumor size and differentiation. The median follow-up duration was 47.3 months (range: 2~152 months). Survival rate was not different according to resection type. Recurrent cases were one patient from each group. They were all submucosal tumors. CONCLUSIONS: The local resection is safe treatment modality for early colorectal cancer. However, case selection for local resection should be cautious because submucosal cases have more recurrent potential. Longterm follow-up will be needed to achieve safety of early colorectal cancer.

Transduodenal Local Resection for Low Risk Group Ampulla of Vater Cancer Patients

PURPOSE: A carcinoma of the ampulla of Vater has more favorable prognosis than other malignant tumors of the periampullary region, because it is symptomatic at an early stage. However, local resection of an ampullary carcinoma remains controversial. The aim of this study was to evaluate the treatment results of ampulla of Vater carcinomas, according to operation type in low risk group patients. METHODS: The records of 17 low risk group patients, among 120 patients with ampulla of Vater cancer, who underwent curative surgery beyween 1992 and 2002, were reviewed. All specimens were critically reviewed by a single expert pathologist. The relationship between surgical outcomes and operation type were assessed. RESULTS: There were 10 men and 7 women, with a median age of 57.8 years. 13 of the 17 patients underwent the Whipples operation or a PPPD, and 4 underwent a transduodenal local resection (TDLR). The operation time was shorter in the TDLR group, and was statistically significant. Among the 17 patients, only one had a recurrence in the inguinal area 33 months after the PD. CONCLUSION: Transduodenal local resection is a recommendable operation for low risk Ampulla of Vater cancer patients. During the operation, it is essential to accurately evaluate the depth of invasion, cell differentiation and positivity of the resection margin using frozen sections.

Glomus Tumor of the Stomach: 1 Case report

Glomus tumors are maturely organized proliferations of glomus cells and vascular channels. Such tumors are rare in the stomach, and only two cases have been reported in Korea. Because specific clinical or radiologic features are not associated with the glomus tumor, it can be recognized only by histologic characteristics. Although available data are inadequate for determining the histogenesis of this tumor, it may represent a hamartoma rather than a neoplastic disease. The treatment of choice is local resection. In frozen sections, it may be misidentified as a carcinoid tumor, leading to more extensive surgery than required for cure. We report a case of a glomus tumor of the stomach in a 30-year-old female patient who was operated on, and we present a review of the literature on this subject.

Glomus Tumor of the Stomach: 1 Case report

Glomus tumors are maturely organized proliferations of glomus cells and vascular channels. Such tumors are rare in the stomach, and only two cases have been reported in Korea. Because specific clinical or radiologic features are not associated with the glomus tumor, it can be recognized only by histologic characteristics. Although available data are inadequate for determining the histogenesis of this tumor, it may represent a hamartoma rather than a neoplastic disease. The treatment of choice is local resection. In frozen sections, it may be misidentified as a carcinoid tumor, leading to more extensive surgery than required for cure. We report a case of a glomus tumor of the stomach in a 30-year-old female patient who was operated on, and we present a review of the literature on this subject.

Local resection for the treatment of early rectal cancer / 中国普通外科杂志

0 05). The postoperative complication developed in 3 57% for local resection, which was statistically lower than that for radical operation of 25 8% (? 2=7 63, P