St.Gallen consensus on safe implementation of transanal total mesorectal excision

被引:121
作者
Adamina, Michel [1 ,2 ]
Buchs, Nicolas C. [3 ]
Penna, Marta [4 ]
Hompes, Roel [5 ]
机构
[1] Cantonal Hosp Winterthur, Dept Surg, Brauerstr 15,Postfach 834, CH-8401 Winterthur, Switzerland
[2] Univ Basel, Basel, Switzerland
[3] Univ Hosp Geneva, Dept Surg, Geneva, Switzerland
[4] Univ Hosp Oxford, Dept Colorectal Surg, Oxford, England
[5] Acad Med Ctr, Dept Surg, Amsterdam, Netherlands
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2018年 / 32卷 / 03期
关键词
Rectal cancer; Transanal total mesorectal excision; Guidelines; Oncology; EXTRAMURAL VASCULAR INVASION; LOW ANTERIOR RESECTION; RECTAL-CANCER; LOCAL RECURRENCE; ENDOSCOPIC MICROSURGERY; PROGNOSTIC-SIGNIFICANCE; ANASTOMOTIC LEAKAGE; SURGERY; QUALITY; MRI;
D O I
10.1007/s00464-017-5990-2
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background The management of rectal cancer has evolved over the years, including the recent rise of Transanal Total Mesorectal Excision (TaTME). TaTME addresses the limitations created by the bony confines of the pelvis, bulky tumours, and fatty mesorectum, particularly for low rectal cancers. However, guidance is required to ensure safe implementation and to avoid the pitfalls and potential major morbidity encountered by the early adopters of TaTME. We report a broad international consensus statement, which provides a basis for optimal clinical practice. Methods Forty international experts were invited to participate based on clinical and academic achievements. The consensus statements were developed using Delphi methodology incorporating three successive rounds. Consensus was defined as agreement by 80% or more of the experts. Results A total of 37 colorectal surgeons from 20 countries and 5 continents (Europe, Asia, North and South America, Australasia) contributed to the consensus. Participation to the iterative Delphi rounds was 100%. An expert radiologist, pathologist, and medical oncologist provided recommendations to maximize relevance to current practice. Consensus was obtained on all seven different chapters: patient selection and surgical indication, perioperative management, patient positioning and operating room set up, surgical technique, devices and instruments, pelvic anatomy, TaTME training, and outcomes analysis. Conclusions This multidisciplinary consensus statement achieved more than 80% approval and can thus be graded as strong recommendation, yet acknowledging the current lack of high level evidence. It provides the best possible guidance for safe implementation and practice of Transanal Total Mesorectal Excision.
引用
收藏
页码:1091 / 1103
页数:13
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