Annals of Coloproctology

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Original Article

Malignant disease, Rectal cancer, Functional outcomes

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma: Osama Eldamshety, Sherif Kotb, Ashraf Khater, Sameh Roshdy, Mohamed Elashry, Mohamed S. Zahi, Hend M. Hamdey Rashed Elkalla, Waleed Elnahas, Omar Farouk, Adel Fathi, Ahmed Senbel, Emad-Eldeen Hamed, Khaled Abdelwahab, Islam Abdou Elzahby, Ahmed abdallah, Mahmoud Abdelaziz, Emanuele Lezoche; Ann Coloproctol. 2020;36(3):148-154. Published online April 20, 2020; DOI: https://doi.org/10.3393/ac.2018.07.19

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Background
The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma.
Methods
In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year.
Results
Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%).
Conclusion
Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function

Citations

Citations to this article as recorded by

Transanal Minimally Invasive TME (TaTME) Versus Non-Endoscopic Transanal Intersphincteric Resection of Post-Neoadjuvant Ultralow Rectal Adenocarcinoma: A Multicentric, Matched Case–Control Study
Osama Eldamshety, Mohamed Abdekhalek, Amir M. Zaid, Essam Attia, Mohamed Zuhdy, Emanuel Lezoche, Giovanni Lezoche, Enjy Mosaad, Marwa Abogabal, Islam Elzahby
Indian Journal of Surgery.2025; 87(5): 912. CrossRef
Pathologic Implications of Magnetic Resonance Imaging-detected Extramural Venous Invasion of Rectal Cancer
Hyun Gu Lee, Chan Wook Kim, Jong Keon Jang, Seong Ho Park, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Clinical Colorectal Cancer.2023; 22(1): 129. CrossRef
International Society of University Colon and Rectal Surgeons survey of surgeons’ preference on rectal cancer treatment
Audrius Dulskas, Philip F. Caushaj, Domas Grigoravicius, Liu Zheng, Richard Fortunato, Joseph W. Nunoo-Mensah, Narimantas E. Samalavicius
Annals of Coloproctology.2023; 39(4): 307. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
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In Ja Park
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Hyo Seon Ryu, Jin Kim
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Sung Uk Bae
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Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
Seung Mi Yeo, Gyung Mo Son
The Ewha Medical Journal.2022;[Epub] CrossRef
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Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
Is It a Refractory Disease?- Fecal Incontinence; beyond Medication
Chungyeop Lee, Jong Lyul Lee
The Ewha Medical Journal.2022;[Epub] CrossRef
Intraoperative neuromonitoring in rectal cancer surgery: a systematic review and meta-analysis
Athina A. Samara, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Symeonidis, Alexandros Diamantis, Konstantinos Tepetes
International Journal of Colorectal Disease.2021; 36(7): 1385. CrossRef
Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes
Guglielmo Niccolò Piozzi, Seon Hahn Kim
Annals of Coloproctology.2021; 37(6): 351. CrossRef
Functional outcomes after sphincter-preserving surgeries for low-lying rectal cancer: A review
Eun Jung Park, Seung Hyuk Baik
Precision and Future Medicine.2021; 5(4): 164. CrossRef
Simplification or Accuracy: In Assessing Functional Outcomes After Intersphincteric Resection for Low Rectal Cancer
Kyung Jong Kim
Annals of Coloproctology.2020; 36(3): 129. CrossRef

Case Report

Malignant disease

Transanal Endoscopic Microsurgery: Endoscopy Assisted Treatment of Colorectal Anastomotic Stenosis: Giancarlo D'Ambrosio, Antonietta Lamazza, Rossella Palma, Andrea Picchetto, Cristina Panetta, Antonello Trecca, Stefano Pontone, Emanuele Lezoche; Ann Coloproctol. 2020;36(4):285-288. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.30.3

7,108 View
136 Download
3 Web of Science
4 Citations

Abstract PDF

Transanal endoscopic microsurgery (TEM) is a type of natural orifice transluminal endoscopic surgery, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36-year-old woman with a diagnosis of Hirschsprung disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of preanastomotic colon (proximal colon from the anastomosis) was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM-colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.

Citations

Citations to this article as recorded by

Application of transurethral prostate resection instrumentation for treating rectal anastomotic stenosis: Case series
Wenshan Xu, Yujie Qin, Faying Yang, Jun Qian, Yanbo Dong, Song Tu, Jiaxi Yao
Medicine.2023; 102(19): e33799. CrossRef
Eight Years Experience of Transanal Endoscopic Microsurgery
Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali
Journal of Coloproctology.2023; 43(04): e251. CrossRef
Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery
Wei Zhou, Lian Xia, Zian Wang, Gaoyang Cao, Li Chen, Engeng Chen, Wei Zhang, Zhangfa Song
Diseases of the Colon & Rectum.2022; 65(8): 1062. CrossRef
Application of endoscopic technique in completely occluded anastomosis with anastomotic separation after radical resection of colon cancer: a case report and literature review
Junnan Gu, Shenghe Deng, Yinghao Cao, Fuwei Mao, Hang Li, Huili Li, Jiliang Wang, Ke Wu, Kailin Cai
BMC Surgery.2021;[Epub] CrossRef

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