Carannante F, Bianco G, Lauricella S, Mascianà G, Caricato M, Capolupo G T
Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy.
Colorectal Surgery Unit, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy.
Int J Surg Case Rep. 2021 May;82:105870. doi: 10.1016/j.ijscr.2021.105870. Epub 2021 Apr 7.
In the last years, transanal total mesorectal excision (TaTME) has been described in rectal cancer treatment, especially in challenging patients, difficulties in pelvic exposure and limitations of instrumentation improving not only dissection but also the preservation of autonomic pelvic nerves and the achievement of a restorative procedure. Here we report a case report of anterior laparoscopic rectal resection for adenocarcinoma of the high-mid rectum converted to transanal approach.
A 69-year-old male presented hepatic nodules during radiological follow-up for prostate cancer treated with radical prostatectomy and adjuvant radiotherapy (70 Gy). The biopsy of the lesion demonstrated the presence of a metastatic lesion of an adenocarcinoma, with suspected intestinal origin. Then, we perform an endoscopic examination, which showed the presence of a rectal lesion, which cause a bowel stenosis extended from the middle part to the upper part of the rectum. After chemoradiotherapy, an anterior rectal resection was performed. During surgery we could not perform the resection of the rectum due the thickness and fibrosis of the tissue, despite we used different branded mechanical stapler. So, we decided to complete the surgical treatment starting a TaTME procedure with resolution of the problem.
TaTME is a relatively new technique that had already become a valid option in the treatment of low rectal cancer, and, nowadays, also in the treatment of inflammatory bowel disease. As reported in literature, this technique has a number of advantages, especially in narrow pelvis and it is very useful in low rectal surgery.
This case report aims to describe the possible use of TaTME procedure as a rescue also when this approach is not the first choice.
在过去几年中，经肛门全直肠系膜切除术（TaTME）已被应用于直肠癌治疗，尤其是在具有挑战性的患者中，骨盆暴露困难和器械限制不仅改善了手术分离，还有助于保留自主盆腔神经并实现恢复性手术。在此，我们报告一例高-中直肠腺癌经腹腔镜前路直肠切除术转为经肛门入路的病例报告。
一名69岁男性在接受前列腺癌根治术及辅助放疗（70 Gy）后的影像学随访中发现肝脏结节。病变活检显示存在腺癌转移灶，怀疑来自肠道。随后，我们进行了内镜检查，发现直肠存在病变，该病变导致直肠狭窄从中部延伸至直肠上部。放化疗后，进行了直肠前路切除术。手术过程中，尽管使用了不同品牌的机械吻合器，但由于组织增厚和纤维化，我们无法完成直肠切除。因此，我们决定通过开展TaTME手术来解决问题，从而完成手术治疗。
TaTME是一种相对较新的技术，已经成为低位直肠癌治疗的有效选择，如今在炎性肠病治疗中也有应用。如文献报道，该技术具有诸多优势，尤其是在骨盆狭窄的情况下，在低位直肠手术中非常有用。
本病例报告旨在描述即使TaTME手术并非首选方法时，其作为补救措施的可能应用。
