Abstract
We began applying laparoscopic techniques to colon and rectal surgery at the Cleveland Clinic Florida over 25 years ago. During those years, we have refined our approach and for many years have routinely employed minimally invasive techniques for proctectomy for rectal cancer. Our operative planning begins with a thorough preoperative assessment which includes a rectal cancer protocol synoptic report, pelvic MRI, and endoscopy to locally stage the tumor as well as a CT of the chest, abdomen and pelvis. All patients meet with an enterostomal therapy nurse for counseling and stoma marking as well as a colorectal nurse for preoperative education. All patients undergo a mechanical cathartic and oral and parenteral bowel prep.
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References
Jafari MD, Wexner SD, Martz JE, et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. Am Coll Surg. 2015;220(1):82–92.e1. doi: 10.1016/j.jamcollsurg. 2014.09.015. Epub 2014 Sep 28.
Boutros M, Hippalgaonkar N, Silva E, et al. Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Diseases of the Colon & Rectum 2013;56(6):679–88.
van der Pas MH, Haglind E, Cuesta MA, et al. COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. A randomized controlled trial showed significant oncologic superiority particular for distal rectal tumors for both the surrogate short term histopathologic and long term tumor recurrence and survival outcomes. Lancet Oncol. 2013;14(3):210–8.
Bonjer HJ, Deijen CL, Abis GA, et al. COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. (COLOR II). N Engl J Med. 20152;372(14):1324–32.
Arezzo A, Passera R, Salvai A, et al. Laparoscopy for rectal cancer is oncologically adequate: a systematic review and meta-analysis of the literature. Surg Endosc. 2015;29(2):334–48. doi: 10.1007/s00464-014-3686-4. Epub 2014 Jul 10.
Stevenson AR, Solomon MJ, Lumley JW, et al. ALaCaRT Investigators. Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA. 20156;314(13):1356–63.
Fleshman J, Branda M, Sargent DJ, et al. Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes: The ACOSOG Z6051 Randomized Clinical Trial. JAMA. 2015;314(13):1346–55.
Garfinkle R, Boutros M, Hippalgaonkar N, et al. The transanal approach has further facilitated our ability to perform TME with anastomosis at the dentate line without any oncologic compromise. Surg Endosc. 2016;30(7):2840–7.
Lacy AM, Tasende MM, Delgado S, et al. Transanal Total Mesorectal Excision for Rectal Cancer: Outcomes after 140 Patients. J Am Coll Surg. 2015;221(2):415–23.
Wexner SD, Berho M. Transanal total mesorectal excision of rectal carcinoma: evidence to learn and adopt the technique. Ann Surg. 2015;261(2):234–6.
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Wexner, S., Osborne, M. (2017). Surgical Technique and Difficult Situations from Steven Wexner (Laparoscopic). In: Korenkov, M., Germer, CT., Lang, H. (eds) Gastrointestinal Operations and Technical Variations. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49878-1_49
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DOI: https://doi.org/10.1007/978-3-662-49878-1_49
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