The usefulness of TaTME for low anterior resection for frail patients in exclusive spinal and/or epidural anaestyhesia
EAES Academy. Tierno S. 07/05/22; 362997; P040
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Abstract
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Purpose:
Invasive rectal cancer is predominantly a disease of older adults with a high likelihood of suffering from concomitant diseases. In these patients, the risks associated with general anaesthesia during radical proctectomy can be the limiting factor of performing an otherwise indicated radical and minimally invasive procedure. To overcome this limitation, we analysed the feasibility of performing a trans-anal total mesorectal excision with disposable platform in exclusive spinal and/or epidural anaesthesia.
Methods:
Between January 2020 and December 2021, five patients underwent low anterior resection with trans-anal total mesorectal excision (TaTME) in exclusive spinal and/or epidural anaesthesia. These patients were unfit to undergo radical procetectomy in general anaesthesia. Patient were male with a bulky low rectal cancer. All underwent neoadiuvant chemioradiotherapy 8 weeks before surgery. Using a GelPoint path trans-anal platform, the rectum and mesorectum was fully mobilized until the peritoneal reflection was reached. A purse string suture is fashioned to close the distal rectal stump. The abdominal part was accomplished through a small Pfannesteil incision with ligation of the mesenteric artery and dissection of the left colon between the Toldt’s and Gerota’s fascia.
Results:
All five procedures could be performed under strict regional anaesthesia. Mean BMI was 29, mean operation time was 133 min (range 90-142 min), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 12.8 days (range 7-16 days). Three of five patients suffered of minor complication according to Clavie Dindo Classification.
Conclusion:
Performance of low anterior resection in exclusive spinal and/or epidural anaesthesia following optimal oncologic outcomes is feasible. TaTME is a usufllness techinique which combines mini-invasive surgery and correcto oncological principle for low rectal cancer particularly in those patients who would be otherwise unfit to undergo radical procetectomy in general anaesthesia.
Invasive rectal cancer is predominantly a disease of older adults with a high likelihood of suffering from concomitant diseases. In these patients, the risks associated with general anaesthesia during radical proctectomy can be the limiting factor of performing an otherwise indicated radical and minimally invasive procedure. To overcome this limitation, we analysed the feasibility of performing a trans-anal total mesorectal excision with disposable platform in exclusive spinal and/or epidural anaesthesia.
Methods:
Between January 2020 and December 2021, five patients underwent low anterior resection with trans-anal total mesorectal excision (TaTME) in exclusive spinal and/or epidural anaesthesia. These patients were unfit to undergo radical procetectomy in general anaesthesia. Patient were male with a bulky low rectal cancer. All underwent neoadiuvant chemioradiotherapy 8 weeks before surgery. Using a GelPoint path trans-anal platform, the rectum and mesorectum was fully mobilized until the peritoneal reflection was reached. A purse string suture is fashioned to close the distal rectal stump. The abdominal part was accomplished through a small Pfannesteil incision with ligation of the mesenteric artery and dissection of the left colon between the Toldt’s and Gerota’s fascia.
Results:
All five procedures could be performed under strict regional anaesthesia. Mean BMI was 29, mean operation time was 133 min (range 90-142 min), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 12.8 days (range 7-16 days). Three of five patients suffered of minor complication according to Clavie Dindo Classification.
Conclusion:
Performance of low anterior resection in exclusive spinal and/or epidural anaesthesia following optimal oncologic outcomes is feasible. TaTME is a usufllness techinique which combines mini-invasive surgery and correcto oncological principle for low rectal cancer particularly in those patients who would be otherwise unfit to undergo radical procetectomy in general anaesthesia.
Purpose:
Invasive rectal cancer is predominantly a disease of older adults with a high likelihood of suffering from concomitant diseases. In these patients, the risks associated with general anaesthesia during radical proctectomy can be the limiting factor of performing an otherwise indicated radical and minimally invasive procedure. To overcome this limitation, we analysed the feasibility of performing a trans-anal total mesorectal excision with disposable platform in exclusive spinal and/or epidural anaesthesia.
Methods:
Between January 2020 and December 2021, five patients underwent low anterior resection with trans-anal total mesorectal excision (TaTME) in exclusive spinal and/or epidural anaesthesia. These patients were unfit to undergo radical procetectomy in general anaesthesia. Patient were male with a bulky low rectal cancer. All underwent neoadiuvant chemioradiotherapy 8 weeks before surgery. Using a GelPoint path trans-anal platform, the rectum and mesorectum was fully mobilized until the peritoneal reflection was reached. A purse string suture is fashioned to close the distal rectal stump. The abdominal part was accomplished through a small Pfannesteil incision with ligation of the mesenteric artery and dissection of the left colon between the Toldt’s and Gerota’s fascia.
Results:
All five procedures could be performed under strict regional anaesthesia. Mean BMI was 29, mean operation time was 133 min (range 90-142 min), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 12.8 days (range 7-16 days). Three of five patients suffered of minor complication according to Clavie Dindo Classification.
Conclusion:
Performance of low anterior resection in exclusive spinal and/or epidural anaesthesia following optimal oncologic outcomes is feasible. TaTME is a usufllness techinique which combines mini-invasive surgery and correcto oncological principle for low rectal cancer particularly in those patients who would be otherwise unfit to undergo radical procetectomy in general anaesthesia.
Invasive rectal cancer is predominantly a disease of older adults with a high likelihood of suffering from concomitant diseases. In these patients, the risks associated with general anaesthesia during radical proctectomy can be the limiting factor of performing an otherwise indicated radical and minimally invasive procedure. To overcome this limitation, we analysed the feasibility of performing a trans-anal total mesorectal excision with disposable platform in exclusive spinal and/or epidural anaesthesia.
Methods:
Between January 2020 and December 2021, five patients underwent low anterior resection with trans-anal total mesorectal excision (TaTME) in exclusive spinal and/or epidural anaesthesia. These patients were unfit to undergo radical procetectomy in general anaesthesia. Patient were male with a bulky low rectal cancer. All underwent neoadiuvant chemioradiotherapy 8 weeks before surgery. Using a GelPoint path trans-anal platform, the rectum and mesorectum was fully mobilized until the peritoneal reflection was reached. A purse string suture is fashioned to close the distal rectal stump. The abdominal part was accomplished through a small Pfannesteil incision with ligation of the mesenteric artery and dissection of the left colon between the Toldt’s and Gerota’s fascia.
Results:
All five procedures could be performed under strict regional anaesthesia. Mean BMI was 29, mean operation time was 133 min (range 90-142 min), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 12.8 days (range 7-16 days). Three of five patients suffered of minor complication according to Clavie Dindo Classification.
Conclusion:
Performance of low anterior resection in exclusive spinal and/or epidural anaesthesia following optimal oncologic outcomes is feasible. TaTME is a usufllness techinique which combines mini-invasive surgery and correcto oncological principle for low rectal cancer particularly in those patients who would be otherwise unfit to undergo radical procetectomy in general anaesthesia.
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