Modificación a la escisión mesorrectal total transanal

Modificación a la escisión mesorrectal total transanal para el tratamiento del cáncer de recto bajo y medio

Modified transanal total mesorectal excision for low rectal cancer

M. Labalde Martínez*, C. Nevado García*, P. Peláez Torres*, S. Lorenzo Mañas*, D. Alías Jiménez*, A. Vivas López*, F.J. García Borda*, E. Ferrero Herrero*

* Servicio de Cirugía General, Aparato Digestivo y Trasplante de
     Órganos Abdominales. Unidad de Cirugía Colorrectal.
     Hospital Universitario 12 de Octubre. Madrid (España).

DOI: https://doi.org/10.14679/3506

Resumen:

Introducción: Se proponen modificaciones a la escisión mesorrectal total transanal que consisten fundamentalmente en realizar la escisión mesorrectal por vía transanal sólo de los planos más distales. El objetivo es describir los resultados del TaTME modificado. Material y métodos: 15 pacientes (8 varones y 7 mujeres) con una edad de 68 (48-76) años con cáncer de recto medio-bajo son sometidos a TaTME modificado. Se coloca la plataforma Gel-point transanal para la creación del neumorrecto estable. Bajo visualización directa del tumor se cierra el recto con una sutura en bolsa de tabaco. Se procede a la rectotomía y se inicia la escisión mesorrectal total de los planos más distales hasta liberar y movilizar sólo el mesorrecto distal circunferencialmente. Bajo neumoperitoneo se procede a la escisión mesorrectal total desde proximal a distal hasta encontrarse con el plano más distal trabajado en la fase transanal. Se extrae la pieza por el ano, se secciona el recto y se cierra el muñón rectal con una segunda bolsa de tabaco. La anastomosis colorrectal con una endograpadora circular evitando la técnica del doble grapado. Resultados: 13 casos eran cT3 y 5 de N+. Recibieron neoadyuvancia 11 pacientes. En todos los casos la escisión mesorrectal total fue completa y los márgenes distal y radial circunferencial estaban libres de enfermedad. No se registraron complicaciones postoperatorias ni fístulas. La estancia hospitalaria fue de 7 (6-8) días. No hubo reintervenciones y un paciente reingresó por suboclusión intestinal. Conclusión: Las modificaciones descritas en la técnica de TaTME son factibles y seguras.
Palabras claves: escisión mesorrectal total transanal, cáncer de recto, TATME

Abstract:

Introduction. We propose modifications to transanal total mesorectal excision consisting on performing the total mesorectal excision by transanal approach only of the most distal planes of the pelvis. The aim is to describe the results of the modified TaTME. Material and methods. 15 patients (8 males and 7 females) with a mean age of 68 (48-76) years old with mid-low rectal cancer underwent modified to TaTME. Gel-point transanal paltform was used to create a stable pneumorrectum. Under direct visualization of the tumour the rectum is closed using a purse-string suture. Rectotomy was performed and the total mesorectal excision was initiated from the most distal plane to mobilize and realease circumferentially the distal mesorectum. Under neumoperitoneum total mesorectal excision was performed from proximal to distal plane and finally the rendez-vous point was found. The piece was extracted through the anus, the rectum was sectionated and the rectal stump was closed with a second purse-string suture. Results. 13 cases were cT3 and 5 N+. 11 patients received neadjuvant therapy. The rate of complete total mesorectal excision, rate of free distal margin and circumferential radial margin were 100 %, 100 % and 100 % respectively. There were not postoperative complications and anastomotic leaks. There were not reinterventions and one patient was readmitted because of intestinal suboclusion. Conclusion. The modifications to transanal total mesorectal excision described in this study were feasible and secure.
Keywords: trananal toral mesorectal excision, carcinoma of rectum, TATME

Bibliografía

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