Our Summary

This research paper is about a type of surgery called ’transanal total mesorectal excision’ (taTME). This is a procedure used to treat rectal cancer. The researchers wanted to compare this method with another procedure, the laparoscopic total mesorectal excision (TME).

To do this, they looked at all the studies on this subject that were published in English between January 2010 and August 2017. They focused on several outcomes, including the length of the cut made during surgery (the resection margin) and the quality of the tissue removed.

They found that in comparison with the laparoscopic method, the taTME method resulted in a longer cut, a lower rate of positive resection margins (a bad thing), and a longer distal resection margin. However, they didn’t find any significant differences in other outcomes.

This suggests that the taTME method might have some advantages over the laparoscopic method. However, they also point out that all the studies they looked at were observational, and more rigorous randomized controlled trials (RCTs) are needed.

FAQs

  1. What is ’transanal total mesorectal excision’ (taTME) used for?
  2. How does the taTME method compare to the laparoscopic total mesorectal excision (TME) method in treating rectal cancer?
  3. What further research is suggested to validate the advantages of the taTME method?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to make sure to follow all post-operative care instructions, including taking all prescribed medications, keeping the surgical site clean and dry, and attending all follow-up appointments. It is also important to avoid heavy lifting, strenuous activities, and certain foods that may cause discomfort or complications during the recovery period. Additionally, maintaining a healthy diet and staying hydrated can help promote healing and reduce the risk of complications.

Suitable For

Patients who are typically recommended for proctectomy include those with:

  1. Rectal cancer: Proctectomy is commonly recommended for patients with rectal cancer, especially those with advanced stages of the disease.

  2. Inflammatory bowel disease (IBD): Patients with severe cases of inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, may require a proctectomy if other treatments have been ineffective in managing their symptoms.

  3. Rectal prolapse: Proctectomy may be recommended for patients with severe rectal prolapse that does not respond to conservative treatments.

  4. Familial adenomatous polyposis (FAP): Patients with FAP, a genetic condition that causes the development of numerous polyps in the colon and rectum, may require a proctectomy to reduce their risk of developing colorectal cancer.

  5. Chronic constipation: In some cases, patients with chronic constipation that does not respond to other treatments may be recommended for a proctectomy to improve their quality of life.

Overall, the decision to recommend proctectomy for a patient will depend on their specific condition, symptoms, and overall health status, and should be made in consultation with a multidisciplinary team of healthcare providers.

Timeline

Before the proctectomy:

  1. Patient is diagnosed with rectal cancer and undergoes various tests and imaging to determine the extent of the disease.
  2. Patient discusses treatment options with their healthcare team, including surgery.
  3. Patient undergoes pre-operative preparations, which may include bowel preparation and dietary restrictions.
  4. Patient meets with their surgeon to discuss the procedure, potential risks, and expected outcomes.

After the proctectomy:

  1. Patient undergoes the proctectomy procedure, either through taTME or laparoscopic TME.
  2. Patient is closely monitored in the hospital for any complications or side effects.
  3. Patient may experience pain, discomfort, and changes in bowel habits post-surgery.
  4. Patient undergoes follow-up appointments with their healthcare team to monitor their recovery and discuss any further treatment options, such as chemotherapy or radiation therapy.
  5. Patient embarks on a rehabilitation and recovery plan, which may include physical therapy and dietary changes.
  6. Patient continues to be monitored for any signs of cancer recurrence or long-term side effects of the surgery.

What to Ask Your Doctor

  1. What is a proctectomy and why is it necessary in my case?
  2. What are the potential risks and complications associated with a proctectomy?
  3. What is the difference between a transanal total mesorectal excision (taTME) and a laparoscopic total mesorectal excision (TME)?
  4. Why are you recommending the taTME method over the laparoscopic method for my case?
  5. How experienced are you in performing taTME procedures?
  6. What is the expected recovery time and post-operative care for a proctectomy?
  7. Will I need a temporary or permanent ostomy after the surgery?
  8. How will a proctectomy affect my bowel function and quality of life in the long term?
  9. Are there any alternative treatments or procedures that I should consider before undergoing a proctectomy?
  10. Are there any ongoing clinical trials or research studies related to proctectomies that I should be aware of?

Reference

Authors: Jiang HP, Li YS, Wang B, Wang C, Liu F, Shen ZL, Ye YJ, Wang S. Journal: Surg Endosc. 2018 Jun;32(6):2632-2642. doi: 10.1007/s00464-018-6103-6. Epub 2018 Feb 20. PMID: 29464401