Our Summary

This research paper discusses a surgical procedure called transanal total mesorectal excision (TaTME), which is used to treat rectal cancer. This method was developed to solve problems that are often encountered in pelvic surgery, especially for rectal cancer. It’s particularly useful in cases where the patient has a high body fat percentage or a narrow pelvis, which can make traditional abdominal surgery difficult. Like any new method, there is a learning curve for surgeons, but it’s important to make sure this doesn’t harm patients. In the hands of a well-trained surgeon, TaTME could be a valuable tool for treating difficult cases of rectal cancer. It’s not intended to replace traditional abdominal surgery, but rather to complement it.

FAQs

  1. What is transanal total mesorectal excision (TaTME) and what problems does it aim to solve in pelvic surgery?
  2. How does visceral obesity and a narrow bony pelvis affect the transanal part of the proctectomy procedure?
  3. Does transanal total mesorectal excision (TaTME) replace the abdominal approach in proctectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to ensure they have a clear understanding of the procedure, including the potential benefits and risks. It is important for patients to communicate openly with their healthcare team, ask questions, and follow their post-operative care instructions closely for optimal recovery.

Suitable For

Patients who are typically recommended proctectomy include those with rectal cancer, inflammatory bowel disease (such as ulcerative colitis or Crohn’s disease), severe hemorrhoids, rectal prolapse, and other conditions affecting the rectum. These patients may have failed conservative treatments or have significant complications that warrant surgical intervention. Additionally, patients who are not suitable candidates for traditional abdominal approaches due to factors such as visceral obesity or a narrow bony pelvis may benefit from a transanal total mesorectal excision (TaTME) procedure. In experienced hands, TaTME can overcome challenges in anatomically challenging cases and provide a more effective and less invasive surgical option for these patients.

Timeline

Before a proctectomy, a patient may undergo several tests and consultations to determine the best course of treatment for their condition. This may include imaging studies, such as CT scans or MRI, as well as consultations with colorectal surgeons and other specialists.

During the proctectomy procedure, the patient is placed under general anesthesia and the surgeon removes part or all of the rectum, depending on the extent of the disease. The surgeon may also perform a colostomy or ileostomy to divert waste from the body while the rectum heals.

After the proctectomy, the patient will typically stay in the hospital for a few days to recover. They may experience pain, discomfort, and changes in bowel habits as they adjust to life without a rectum. Physical therapy and dietary changes may be recommended to help with recovery.

Over time, the patient will gradually regain strength and function, although some may experience long-term side effects such as incontinence or sexual dysfunction. Follow-up appointments with the surgeon and other healthcare providers will be necessary to monitor the patient’s progress and address any concerns.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a proctectomy procedure?
  2. What is the expected recovery time and rehabilitation process after a proctectomy?
  3. How will a proctectomy impact my bowel function and quality of life?
  4. Are there any alternative treatment options to consider before proceeding with a proctectomy?
  5. How many proctectomies have you performed and what is your experience with this procedure?
  6. Will I need to undergo additional treatments or therapies after the proctectomy?
  7. How will a proctectomy affect my ability to engage in physical activities or return to work?
  8. What long-term follow-up care will be necessary after a proctectomy?
  9. Are there any specific dietary or lifestyle changes I should make before or after the proctectomy?
  10. Can you provide me with information or resources for support groups or counseling services for individuals who have undergone a proctectomy?

Reference

Authors: Rutgers MLW, Bemelman WA, Khan JS, Hompes R. Journal: Surg Oncol. 2022 Aug;43:101695. doi: 10.1016/j.suronc.2021.101695. Epub 2021 Dec 12. PMID: 34924223