Our Summary

The research paper is about a surgical procedure for rectal cancer called transanal total mesorectal excision (taTME). This method has gained popularity among surgeons as it has potential advantages in operating on the lower part of the pelvis. However, there have been concerns about its safety, leading Norwegian surgeons to temporarily stop using this technique. In response, Canadian surgeons who use taTME have seen the need to create a set of guidelines to ensure the safe adoption and use of this procedure. The authors of this paper have gathered information from the experiences of surgeons who have used taTME in Canada since 2014 and have drafted a statement addressing four areas: the surgical environment, the qualifications of the surgeons, choosing the right patients, and ensuring the quality of the procedure. The authors believe that taTME can be done safely and effectively if these guidelines are followed.

FAQs

  1. What is transanal total mesorectal excision (taTME) and why has it become popular among surgeons?
  2. Why did Norwegian surgeons temporarily stop using the taTME technique?
  3. What are the four areas addressed in the guidelines created by Canadian surgeons for the safe adoption and use of taTME?

Doctor’s Tip

One helpful tip a doctor might give a patient undergoing a proctectomy is to follow the pre-operative instructions carefully, such as fasting before surgery and taking any prescribed medications as directed. It is also important for the patient to communicate any concerns or questions they have with their healthcare team before the procedure. After surgery, following post-operative care instructions, such as proper wound care and activity restrictions, is crucial for a successful recovery. It is important for the patient to attend all follow-up appointments and communicate any changes in symptoms or concerns with their healthcare provider.

Suitable For

Patients who are typically recommended for proctectomy, specifically with the taTME procedure, are those with rectal cancer that is located in the lower part of the pelvis. These patients may have tumors that are difficult to access or remove through traditional surgical approaches, making taTME a potentially beneficial option. Additionally, patients who have undergone previous failed surgeries or radiation therapy in the pelvic area may also be candidates for proctectomy with taTME. It is important for surgeons to carefully assess each patient’s individual case and determine if they are suitable candidates for this procedure based on factors such as tumor size, location, and stage, as well as the patient’s overall health and surgical history. By following the guidelines set forth by the Canadian surgeons in this paper, the safety and effectiveness of proctectomy with taTME can be maximized for the benefit of patients.

Timeline

Before proctectomy:

  1. Patient is diagnosed with rectal cancer and discusses treatment options with their healthcare team.
  2. Patient undergoes preoperative testing and evaluation to determine if they are a suitable candidate for proctectomy.
  3. Patient meets with their surgeon to discuss the procedure, potential risks and benefits, and what to expect during the recovery process.

After proctectomy:

  1. Patient undergoes the proctectomy surgery, which involves removing the rectum and possibly part of the colon.
  2. Patient stays in the hospital for a period of time to recover from the surgery and monitor for any complications.
  3. Patient may experience side effects such as pain, fatigue, changes in bowel function, and emotional distress.
  4. Patient undergoes follow-up appointments with their healthcare team to monitor their recovery, discuss any concerns or complications, and develop a plan for ongoing care and surveillance.

Overall, the patient’s experience before and after proctectomy involves a combination of medical interventions, emotional support, and ongoing monitoring to ensure the best possible outcome and quality of life.

What to Ask Your Doctor

  1. What is a proctectomy and why is it necessary for my condition?
  2. What are the potential risks and complications associated with a proctectomy procedure?
  3. How experienced are you in performing proctectomies, specifically using the taTME technique?
  4. What are the potential benefits of using the taTME technique for my procedure?
  5. How will my recovery process differ if I undergo a proctectomy using the taTME technique compared to other surgical approaches?
  6. Are there any alternative treatment options to consider before proceeding with a proctectomy?
  7. What is the success rate of proctectomies using the taTME technique in treating rectal cancer?
  8. How long will the surgery take and how long can I expect to stay in the hospital?
  9. Will I need any additional treatments or therapies after the proctectomy procedure?
  10. What steps will be taken to ensure the safety and effectiveness of the taTME procedure in my case?

Reference

Authors: Caycedo-Marulanda A, Brown CJ, Chadi SA, Ashamalla S, Lee L, Stotland P, Hameed U, Melich G, Ma G, Letarte F, Karimuddin A, Quereshy F, Phang T, Raval M, Vikis E, Liberman AS, Bouchard A, Bouchard P, Drolet S. Journal: Surg Endosc. 2020 Sep;34(9):3748-3753. doi: 10.1007/s00464-020-07680-8. Epub 2020 Jun 5. PMID: 32504263