Transanal Endoscopic Microsurgery In Rectal Cancer

Cancer of the rectum continues to be a significant health problem in industrialized co- tries around the world. Relative 5-year survival rates in the USA for cancer of the rectum from 1995 to 2001 improved to 65%, a 15% improvement over 20 years (American Cancer Society, 2007). The reasons for this dramatic improvement include more accurate pr- perative staging, aggressive neoadjuvant therapy and improved surgical technique as well as specialty-trained surgeons. Despite advances in nonoperative techniques of radiation therapy, chemotherapy and immunotherapy, surgical extirpation continues to be the cornerstone of curative treatment of this potentially lethal disease. Radical cancer excision with total mesorectal excision has become the preferred surgical procedure for even early-stage cancers of the rectum. Over the past decade the enthusiasm for local excision (and other local treatments) has given way to persuasive (predominantly retrospective) evidence that the incidence of locoregional recurrence due to unsuspected lymphatic metastases and positive lateral margins is un- ceptably high even for stage T tumors. Vigorous attempts to find characteristics of the 1 tumor that would allow successful local treatments are ongoing.

For more than 25 years, Current Therapy in Colon and Rectal Surgery has been the go-to resource for preparing for the American Board of Surgery certification exam. Following in this tradition, the 3rd Edition offers a comprehensive, contemporary summary of treatment options for colorectal diseases, with a focus on practical clinical science and applications. In a single, portable volume, you’ll find complete coverage of new diagnostic modalities, medical therapeutics, and surgical treatment options, including minimally invasive surgery. Easy to read and digest, it provides a quick consultation with experts on the essentials of colon and rectal surgery. Consult this title for a quick overview before you enter the OR, and use it as a review tool for board certification and recertification. Nearly 100 succinct chapters, just 3 or 4 pages each, written by leading experts in colorectal surgery. Five chapters devoted exclusively to different aspects of rectal cancer. Other key topics include minimally invasive surgery, reparative surgery, maturing outcomes, and managing surgical risk. New chapters focus on hot topics such as intestinal transplants, enhanced recovery programs, and the management of peristomal hernias. Updated information on the molecular biology of colorectal cancer and its implications for therapy.

This book describes the various procedures, including surgery through the abdominal wall, through a transanal access or by the union of both, using an open, laparoscopic, or robotic approach. Worldwide pioneers for each technique are invited as authors and portray in step-by-step detail about each procedure. Of the 32 chapters, 23 are dedicated only for the surgical procedures. Each chapter is enriched by numerous figures, which complement the text, permitting the understanding of each surgical technique from its beginning until the last step. Eight additional chapters are dedicated to the clinical and anatomical aspects of rectal cancer. In the last decade there has been an impressive evolution in the treatment of patients with rectal cancer, with a focus not only on the preservation of a cancer-free life, but the quality of that life. This book has been written to be useful for everyone involved in rectal cancer management. From internists, gastroenterologists, endoscopists, oncologists, radiotherapists and radiologists involved in the treatment of rectal cancer during their daily practice, to surgeons specialized in colorectal surgery, to junior faculty to trainees, all interested in new and innovative techniques.

The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. [...] Insufflation of the rectum is used to improve the field of vision and access.3 One of the disadvantages with the TEM procedure is that it does not provide information on lymph node status.4 The rate of nodal metastases in selected early rectal cancers (T1 tumours with good differentiation) is low (around 3%; although it can go up to 25% in tumours with poor differentiation): this may be a factor i [...] The death in the AR group was due to distant metastasis, and it was not clear whether the death in the TEM group was related to the primary cancer. [...] There was no difference in overall survival in the TEM group compared to the control group.5,7 In the two studies that discussed bowel function, they found that bowel function recovered after TEM with time.6,9 The complications included blood loss, urinary retention, sepsis and dehiscence and one study reported that higher complications occurred in the radical resection groups compared to the TEM [...] Another study reported a higher complication rate in the TEM group compared to the LE group, and suggested the effect of the learning curve was responsible for the higher complication rate.8.

This book provides an educational resource of modern and advanced operative techniques for patients with GI cancers. The textbook is designed to provide a step-by-step surgical approach, highlighting key learning points and potential operative pitfalls. When appropriate, two or more different approaches on an operative procedure are presented to provide additional perspective on surgical techniques. Written descriptions of laparoscopic and robotic cancer operations are paired with online video presentations of the same cancer operation. Written by experts in the field, Surgery for Cancers of the Gastrointestinal Tract: A Step-by-Step Approach provides a concise summary of the current management of each GI cancer and is of great utility to not only surgeons at all levels of training, but also for surgeons in practice who seek to reinforce or learn new surgical techniques.

​This book captures cornerstone developments in a new body of knowledge and provides an expert resource on a “hot topic” in rectal surgery. Transanal minimally invasive surgery (TAMIS) was designed for local excision of select rectal neoplasms, however soon it became realized that the TAMIS technique could be used for applications beyond local excision, most notably for transanal total mesorectal excision (taTME). This new operative technique has revolutionized our approach to the distal rectum by allowing for improved access, especially in obese male patients with an android pelvis, and by minimizing abdominal wall access trauma. The endpoints of improved oncologic resection, as defined by mesorectal envelope completeness, negative circumferential resection margins, and negative distal margin, are assessed. This book details controversies, pitfalls, and future directions of taTME and TAMIS. Chapters are authored by those on the forefront of innovation with TAMIS and taTME, and each is considered an authority on the topic. Transanal Minimally Invasive Surgery (TAMIS) and Transanal Total Mesorectal Excision (taTME) is a must-have reference for surgeons who are performing this operation and fellows in training who want to completely understand the various nuances of TAMIS and taTME.

This book provides essential didactic content for the SAGES University Masters Program Colorectal Surgery Curriculum. Surgeons seeking to complete the competency, proficiency, or mastery curriculum of the MASTERS Colorectal Pathway for a particular anchoring colorectal procedure will find relevant educational content in this SAGES Manual. Written by experts in the field, each chapter provides detailed guidance on preoperative and peri-procedural considerations for right and left elective and emergency colorectal resections, for both benign and malignant pathologies. Technical pearls and strategies to manage pitfalls and complications are also extensively reviewed along with detailed guidance for both laparoscopic and robotic procedures. The SAGES Manual of Colorectal Surgery provides a wealth of practical guidance to surgeons along their journey to progress from competency to mastery in various minimally invasive approaches to colorectal surgery.

Rectal Cancer: Modern Approaches to Treatment provides a useful overview of the multidisciplinary treatment of rectal cancer with a deeper dive into clinical challenges faced by treating physicians. Written by the leading experts in the field, it provides a practical management guide with an emphasis on the state-of-the-art that will be of value to both novices and experts engaged in rectal cancer treatment.