2 November, 2021
Dr. Antonio de Lacy’s team at Hospital Clínic is a global point of reference in transanal surgery
Surgical techniques are constantly evolving in order to improve the results while minimising the consequences caused by the intervention. One of the routes that is followed to achieve this last step is by reducing, where possible, the incisions employed in order to carry out the intervention. In this regard the approaches that take advantage of the natural orifices of the patient are being used more and more. Transanal total mesorectal excision or TaTME is one of these techniques, developed by the team lead by Dr. Antonio de Lacy, head of the Gastrointestinal Surgery Service at Hospital Clínic of Barcelona and oncology surgeon at barnaclínic+, it is currently considered one of the best treatment options for patients with colon and rectal cancer.
TaTME is one of the most advanced techniques out there for the treatment of colon and rectal cancer and for other pathologies. “It’s a proud moment for us to have developed this technique, that we have carried out for the first time in the world in 2009. And after ten months we used this intervention on all the patients we had with rectal tumours”, explains Dr. Antonio de Lacy, who emphasise that the Hospital Clínic Group has always favoured the development of research and has allowed him to be able to carry out numerous pioneering interventions such as TaTME.
“It’s a proud moment for us to have developed this technique, that we have carried out for the first time in the world in 2009. And after ten months we used this intervention on all the patients we had with rectal tumours”
GLOBAL POINTS OF REFERENCE IN THE MINIMALLY INVASIVE APPROACH
Now, after more than 500 interventions carried out using the TaTME technique, Dr. Antonio de Lacy’s team has become a point of reference in this minimally invasive approach in the world. The technique consists of combining on the one side a resection by laparoscopy, a type of minimally invasive surgery that uses a thin tube that is inserted into the abdomen via a small incision, with the transanal tract recession, or in other words, through the patient’s anus.
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THE TRANSANAL APPROACH OFFERS GREAT BENEFITS FOR PATIENTS
In this way, patients receive a series of benefits related to both quality of life and the results obtained by the intervention. Maybe one of the main advantages is reducing the rate of colostomies, when the patient must carry around a bag of excrement, and in case it were necessary following the intervention, in more than 99% of cases it can be removed after 3 to 6 months.
“Thanks to this type of technique it’s possible to reduce post-op pain and the achieved results also improve given that we can reduce the failure rate in the closing of the wound”, adds Dr. Antonio de Lacy, who also points out that thanks to this technique the surgical intervention time, the length of stay in the hospital and the post-op complications such as infections and dehiscence or spontaneous opening of the wound are able to be reduced by 50%.
“Thanks to TaTME it’s possible to reduce post-op pain and the achieved results also improve given that we can reduce the failure rate in the closing of the wound”
TaTME allows for the removal of colon and rectal cancer in a safer way from an oncology perspective, which means a better chance of survival for patients. By being minimally invasive the surgical trauma of the patient is reduced, complications, infections and time spent in the hospital are decreased. Patients can incorporate this into their daily lives with an improvement in the aesthetic of the surgical scar. “For that reason we are setting up a study in order to check if, as we believe, this technique helps to improve oncological results of the patients, given that we don’t just remove the malignant tumour but the chances of metastasis are reduced as well as the complications for patients post-treatment”, adds Dr. Antonio de Lacy.
MANY POSSIBILITIES FOR TaTME
Colon and rectal cancer are a type of tumour that appears in the long intestine. It’s the third most frequent for men, after prostate cancer and lung cancer, and the second most for women, after breast cancer. It’s a disease that can be prevented and treated, given that during many years this tumour is a polyp that if detected can be removed immediately, avoiding the appearance of cancer. In the removal of these polyps when they are benign and also when they have passed to a malignant state, TaTME is one of the most recommendable techniques.
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Even though the first application of TaTME was in patients with rectal tumours, nowadays its use has been extended to many other pathogens. As well as colon and rectal cancer or benign tumours, it can also be used for intestinal inflammatory disease, rectal stenosis, complex fistulas, fecal incontinence, familial adenomatous polyps, radiation proctitis, the need to remove the rectal stump following a Hartmann operation or reconstruction, as well as post-op and recurring complications.
The factors that make TaTME preferential as an approach in colon or rectal cancer are: the male gender, the distance of the tumour from the anal margin of less than 12cm, a deep or wide pelvis, visceral obesity, BMI of more than 30, prostate hypertrophy, tumour diameter of more than 4cm, distortion of the plane due to neoadjuvance with very low radiotherapy or localisation the tumour requiring a vey precise margin of distal resection. The current trend is to use this technique in all cases of rectal pathology.
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IMAGEN: Hospital Clínic de Barcelona