Publications by authors named "Petr Tsarkov"

26 Publications

  • Page 1 of 1

Step-by-step robotic lateral lymph node dissection for rectal cancer.

Colorectal Dis 2021 Sep 14. Epub 2021 Sep 14.

Clinic of Coloproctology and Minimally Invasive Surgery, Department of Surgery of N.V. Sklifosovsky Clinical Medicine Institute, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

Total mesorectal excision (TME) has significantly reduced local recurrence in rectal cancer surgery. However, the local recurrence rate for low tumours remains high at 36%. Lateral pelvic lymph node (LNs) involvement has been noted in 50% of cases. Lateral metastasis occurs in 15% of middle and low rectal primary tumours.
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http://dx.doi.org/10.1111/codi.15909DOI Listing
September 2021

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

JAMA Surg 2021 Sep;156(9):865-874

Department of Surgery, Skåne University Hospital, Malmö, Sweden.

Importance: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.

Observations: Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.

Conclusions And Relevance: The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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http://dx.doi.org/10.1001/jamasurg.2021.2380DOI Listing
September 2021

Superior mesenteric vessel anatomy features differ in Russian and Chinese patients with right colon cancer: computed tomography-based study.

Chin Med J (Engl) 2021 Jun 7. Epub 2021 Jun 7.

Department of Surgery, Clinic of Colorectal and Minimally Invasive Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119991, Russia Department of Diagnostic Radiology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.

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http://dx.doi.org/10.1097/CM9.0000000000001566DOI Listing
June 2021

A technical guide for everted natural orifice specimen extraction after low anterior resection of the rectum - a video vignette.

Colorectal Dis 2021 03 25;23(3):766-767. Epub 2021 Feb 25.

I. M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia.

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http://dx.doi.org/10.1111/codi.15495DOI Listing
March 2021

Study protocol for an International Prospective Observational Cohort Study for Optimal Bowel Resection Extent and Central Radicality for Colon Cancer (T-REX study).

Jpn J Clin Oncol 2021 Jan;51(1):145-155

Tokyo Medical and Dental University, Tokyo, Japan.

This is a prospective observational cohort study aiming to include 4000 patients with stages I to III colon cancer treated at 35 specialist institutions in Japan, South Korea, Germany, Russia, Lithuania and Taiwan. The anatomical distribution of lymph nodes and feeding arteries are investigated using surgical specimens according to pre-specified categorizing methods using intraoperative anatomical markings. Primary analyses are performed to identify the general principles of metastatic lymph node distribution in terms of its relation to the location of the primary tumor and feeding arteries. Secondary analyses will be used to estimate prognostic outcomes according to bowel resection length and central radicality and will be used to evaluate the quality of resected surgical specimens. Through in-depth lymph node mapping, standardized criteria for the definite area of 'regional' lymph node resection in routine surgical procedures can be identified, which is expected to contribute to international standardization in colon cancer surgery (ClinicalTrials.gov NCT02938481).
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http://dx.doi.org/10.1093/jjco/hyaa115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767979PMC
January 2021

Combined surgical approach for large sacral chordoma resection with pelvic floor reconstruction - a video vignette.

Colorectal Dis 2021 02 24;23(2):566-567. Epub 2020 Nov 24.

I.M. Sechenov First Moscow State Medical University (Sechenov University, Moscow, Russia.

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http://dx.doi.org/10.1111/codi.15436DOI Listing
February 2021

Impact of robotic learning curve on histopathology in rectal cancer: A pooled analysis.

Surg Oncol 2020 Sep 13;34:121-125. Epub 2020 Apr 13.

Section of Colorectal Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA; Department of Surgery, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov Medical University, Moscow, Russia. Electronic address:

Background: A beneficial impact of robotic proctectomy on circumferential resection margin (CRM) is expected due to the robot's articulating instruments in the pelvis. There are however concerns about a negative impact on the quality of total mesorectal excision (TME) due to the lack of tactile feedback. The aim of this study was to assess whether surgeons' learning curve impacted CRM and TME quality.

Methods: In a multicenter study, individual patient data of robotic proctectomy for resectable rectal cancer were pooled. Patients were stratified into two phases of surgeons' learning curve. Cumulative sum (CUSUM) analysis was used to determine the transition from learning phase (LP) to plateau phase (PP), which were compared. CRM was microscopically measured in mm by pathologists. TME quality was classified by pathologists as complete, nearly complete or incomplete. T-test and Chi-squared tests were used to compare continuous and categorical variables, respectively.

Results: 235 patients underwent robotic proctectomy by five surgeons. 83 LP patients were comparable to 152 PP patients for age (p = 0.20), gender (67.5% vs. 65.1% males; p = 0.72), BMI (p = 0.82), cancer stage (p = 0.36), neoadjuvant chemoradiation (p = 0.13), distance of tumor from anal verge (5.8 ± 4.4 vs. 5.5 ± 3.3; p = 0.56). CRM did not differ (7.7 ± 11.4 mm vs. 8.4 ± 10.3 mm; p = 0.62). The rate of complete TME quality was significantly improved in PP patients as compared to LP patients (73.5% vs. 92.1%; p < 0.001).

Conclusion: While learning had no impact on circumferential resection margins, the quality of TME significantly improved during surgeons' plateau phase as compared to their learning phase.
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http://dx.doi.org/10.1016/j.suronc.2020.04.011DOI Listing
September 2020

Extended Colectomy Followed by Cecorectal Anastomosis as a Surgical Treatment Modality in Synchronous Colorectal Cancer.

Case Rep Oncol 2020 May-Aug;13(2):813-821. Epub 2020 Jul 8.

Coloproctology and Minimally Invasive Surgery Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.

Subtotal and extended left colectomies with ileocecal junction preservation represent preferable alternatives in cases of massive involvement of the colon in the pathological process. However, these approaches might be challenging in terms of reconstructive steps. Antiperistaltic cecorectal anastomosis is one of the possible techniques. Still, this type of pouch formation is described mostly in slow-transit constipation surgical management. We report on a patient with synchronous colorectal cancer who underwent extended left colectomy. In the case of compromised vessel anatomy, it was decided to perform antiperistaltic cecorectal anastomosis. We present all clinical and intraoperative patient's data, determining the surgical tactics, and short-term postoperative results. An antiperistaltic cecorectal anastomosis can be considered in nonstandard clinical cases and variable anatomy of the patient.
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http://dx.doi.org/10.1159/000508266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443643PMC
July 2020

3D-printed pubic bone for pelvic ring reconstruction after exenteration for anal cancer recurrence.

Br J Surg 2020 10 26;107(11):e512-e514. Epub 2020 Aug 26.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia.

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http://dx.doi.org/10.1002/bjs.11982DOI Listing
October 2020

"Multi-faceted" COVID-19: Russian experience.

Br J Surg 2020 Oct 21;107(11):e479-e480. Epub 2020 Aug 21.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Coloproctology and Minimally Invasive Surgery, Moscow, Russia.

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http://dx.doi.org/10.1002/bjs.11940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461231PMC
October 2020

Deadlock of proctologic practice in Italy during COVID-19 pandemic: a national report from ProctoLock2020.

Updates Surg 2020 Dec 8;72(4):1255-1261. Epub 2020 Aug 8.

IV Surgery Unit, Treviso Regional Hospital, University of Padua, Padua, Italy.

Proctology is one of the surgical specialties that suffered the most during COVID-19 pandemic. Using data from a cross-sectional worldwide web survey, we aimed to snapshot the current status of proctologic practice in Italy with differences between three macro areas (North, Centre, South). Specialists affiliated to renowned scientific societies with an interest in coloproctology were invited to join a 27-item survey. Predictive power of respondents' and hospitals' demographics on the change of status of surgical activities was calculated. The study was registered at ClinicalTrials.gov (NCT04392245). Of 299 respondents from Italy, 94 (40%) practiced in the North, 60 (25%) in the Centrer and 82 (35%) in the South and Islands. The majority were men (79%), at consultant level (70%), with a mean age of 46.5 years, practicing in academic hospitals (39%), where a dedicated proctologist was readily available (68%). Southern respondents were more at risk of infection compared to those from the Center (OR, 3.30; 95%CI 1.46; 7.47, P = 0.004), as were males (OR, 2.64; 95%CI 1.09; 6.37, P = 0.031) and those who routinely tested patients prior to surgery (OR, 3.02; 95%CI 1.39; 6.53, P = 0.005). The likelihood of ongoing surgical practice was higher in the South (OR 1.36, 95%CI 0.75; 2.46, P = 0.304) and in centers that were not fully dedicated to COVID-19 care (OR 4.00, 95%CI 1.88; 8.50, P < 0.001). The results of this survey highlight important factors contributing to the deadlock of proctologic practice in Italy and may inform the development of future management strategies.
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http://dx.doi.org/10.1007/s13304-020-00860-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414270PMC
December 2020

Surgical Treatment of Sacral Chordoma: The Role of Laparoscopy.

Case Rep Oncol 2020 Jan-Apr;13(1):255-260. Epub 2020 Mar 24.

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.

Sacral chordoma is a rare tumour that represents the most common malignancy of the sacral region. Its diagnosis can be delayed because of unclear clinical manifestation. This tumour can involve surrounding anatomical structure such as the rectum, and its surgical treatment is still challenging. We report on 3 patients with sacral chordoma. Two of them were successfully treated using a laparoscopic approach and one by open surgery. We present all details of the surgical technique and patients' outcome. Minimally invasive methods in the surgical treatment of chordoma allow to perform a radical dissection of the tumour, minimizing the operative trauma. A laparoscopic approach can be considered safe and radical for sacral chordoma treatment.
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http://dx.doi.org/10.1159/000506441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154265PMC
March 2020

Hemorrhoidal artery ligation with Doppler guidance vs digital guidance for grade II-III hemorrhoidal disease treatment: Study protocol clinical trial (SPIRIT Compliant).

Medicine (Baltimore) 2020 Apr;99(15):e19424

Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia.

Introduction: Hemorrhoidal artery ligation (HAL) with Doppler guidance and suture fixation of hemorrhoidal nodes (RAR) is a popular minimally invasive technique for hemorrhoidal disease (HD) treatment which uses an ultrasound probe to detect hemorrhoidal arteries for further ligation. We hypothesized that ultrasound guidance has no advantages over manual hemorrhoidal arteries detection for HD treatment.The aim is to compare the results of HAL-RAR procedure in patients with stage II-III HD with Doppler and manual HA detection.In this ongoing randomized, controlled, single center clinical study 204 patients randomly divides into group A (HAL-RAR with Doppler US navigation) and group B (HAL with manual HA detection and mucopexy) are planned to be included. The primary endpoint was recurrence of any symptoms of HD; secondary endpoints were pain syndrome severity, treatment satisfaction (1 to 5 points), and need for the drug therapy in 30 days and 8 weeks after surgery.

Conclusion: Ultrasound guidance technology of HAL with mucopexy could have the same efficacy the manual HA detection regarding the HD treatment effectiveness and patient satisfaction.
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http://dx.doi.org/10.1097/MD.0000000000019424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220052PMC
April 2020

Classifications and Clinical Assessment of Haemorrhoids: The Proctologist's Corner.

Rev Recent Clin Trials 2021 ;16(1):10-16

Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy.

Background: Haemorrhoidal disease (HD) is a benign condition affecting a considerable part of adult population. HD can be considered a social and economic burden with high impact on patients' lifestyle. Several new techniques and devices have been proposed for HD treatment; however, preoperative assessment is essential and the use of classification system is recommended.

Methods: In the last two decades many studies described the preoperative assessment and several attempts of classification for HD. This review focuses on the most relevant studies found in literature where classification systems and clinical evaluation with differential diagnosis have been evaluated.

Results: The knowledge of classification systems and differential diagnosis for HD has been shown to play a central role in the clinical assessment and the best treatment choice. Although there are new challenging techniques and devices for HD treatment, a preoperative assessment is always mandatory.

Conclusion: Preoperative clinical evaluation is essential for HD patient treatment and outcome. Classification systems are useful for the therapeutic choice and researches on new medical or surgical treatments. In fact, the international guidelines advise several therapeutic options depending on the severity of the HD.
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http://dx.doi.org/10.2174/1574887115666200312163940DOI Listing
January 2021

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019).

Gastroenterol Rep (Oxf) 2020 Feb 24;8(1):5-10. Epub 2020 Jan 24.

Department of Gastric Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, P. R. China.

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.
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http://dx.doi.org/10.1093/gastro/goz067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034234PMC
February 2020

Three-plane Model to Standardize Laparoscopic Right Hemicolectomy with Extended D3 Lymph Node Dissection.

Surg Technol Int 2020 May;36:136-142

Minimally Invasive Surgery, Department of Surgery, Clinic of Colorectal and Minimally Invasive Surgery, I.M. Sechenov First Moscow State Medical, University, Moscow, Russia.

Aim: The purposes of this study were to create a "three-plane model" for laparoscopic right hemicolectomy and to compare short-term outcomes of anterior medial-to-lateral (aM-to-L) and caudal-to-cranial access by retroperitoneal tunneling (Ca-to-Cr), as described based on the three-plane model.

Methods: A three-plane model was developed to clarify the steps of an operation. Consecutive cases of right colon cancer were operated upon with an aM-to-L approach in the earlier period and then with a Ca-to-Cr approach, and postoperative outcomes were evaluated. Short-term results were compared.

Results: Sixty-two patients were divided into aM-to-L (n=29) and Ca-to-Cr (n=33) groups. The two groups did not differ in terms of the patients' baseline characteristics. Median operative time was 220 min (IQR 190-260) for the aM-to-L group and 222.5 min (IQR 180-255) for the Ca-to-Cr group (p=0.73). Estimated blood loss was similar in both groups (p=0.13). Median length of hospital stay was 6 days (IQR 5-8) in the aM-to-L group and 7 days (IQR 6-9) in the Ca-to-Cr group (p=0.17). Median number of harvested lymph nodes was 45.5 (IQR 25-44.9) in the aM-to-L group and 30 (IQR 18-48.5) in the Ca-to-Cr group (p=0.34).

Conclusion: The approach used to reach the superior mesenteric vessels for laparoscopic right hemicolectomy with D3 lymph node dissection does not affect the short-term outcome of the operation. The present three-plane model gives surgeons additional insight to perform this operation.
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May 2020

Perforation of cecum caused by chicken bone under the guise of Crohn's disease.

N Z Med J 2019 10 4;132(1503):100-102. Epub 2019 Oct 4.

Resident, Gastroenterologist, Department of Gastroenterology, Sechenov University, Russia.

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October 2019

Does transanal total mesorectal excision of rectal cancer improve histopathology metrics and/or complication rates? A meta-analysis.

Surg Oncol 2019 Sep 21;30:47-51. Epub 2019 May 21.

Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.

Background: The aim of this meta-analysis was to determine whether transanal total mesorectal excision (taTME) improves histopathology metrics and/or complication rates when compared to robotic total mesorectal excision (R-TME) of resectable rectal cancer.

Methods: MEDLINE, Pubmed, Cochrane Library, and Scopus were systematically searched by two independent researchers. Six observational studies totaling 1,572 patients (811 taTME; 761 R-TME) were included after screening 14 potentially eligible records. Mantel-Haenszel method using odds ratios with 95% confidence intervals (OR (95%CI)) and inverse variance with mean difference with 95% confidence intervals (MD (95%CI)) as an effect measure for dichotomous and continuous variables, respectively, was employed for meta-analysis. Statistical heterogeneity among effect estimates was evaluated using I and Tau.

Results: Circumferential resection margin (CRM) involvement rates (3.8% taTME; 5.3% R-TME) did not differ [OR (95%CI) = 0.86 (0.35, 2.15); p = 0.75] with low among-study heterogeneity (I = 21%). Complication rates (35.4% taTME; 32.3% R-TME) did not differ [OR (95%CI) = 0.92 (0.64, 1.32); p = 0.65], although with moderate among-study heterogeneity (I = 40%). CRM involvement [OR (95%CI) = 0.76 (0.40, 1.43); p = 0.40] and complication rates [OR (95%CI) = 0.84 (0.59, 1.21); p = 0.35] did not significantly differ in subgroup meta-analysis including mid- and low rectal cancer. Distal resection margin (mm) did not significantly differ between the interventions [MD (95%CI) = -0.41 (-1.29, 0.47); p = 0.37].

Conclusions: This meta-analysis found that taTME of rectal cancer does not improve histopathology metrics and complication rates when compared to R-TME.
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http://dx.doi.org/10.1016/j.suronc.2019.05.012DOI Listing
September 2019

Double-barreled Wet Colostomy Versus Separate Urinary and Fecal Diversion in Patients Undergoing Total Pelvic Exenteration: A Cohort Meta-analysis.

Surg Technol Int 2019 11;35:148-152

Section of Colorectal Surgery, Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russia.

Background: The aim of this meta-analysis was to determine whether double-barreled wet colostomy (DBWC) provides similar urinary tract infection rates as separate urinary and fecal diversion (SUFD) in patients undergoing pelvic exenteration.

Methods: The MEDLINE, PubMed, Cochrane Library, and Scopus databases were systematically searched by two independent researchers. The primary endpoint was the urinary tract infection rate. The Mantel-Haenszel method with odds ratios with 95% confidence intervals (OR (95%CI)) was used as an effect measure for dichotomous variables. A random-effects model was used for the meta-analysis. Statistical heterogeneity among effect estimates was evaluated using I2 and Tau2.

Results: Three observational studies that included a total of 257 patients (159 DBWC; 98 SUFD) were included after 14 potentially eligible records were screened. Pooled urinary tract infection rates were 1.9% (3/159) in DBWC and 6.1% (6/98) in SUFD. This difference was not statistically significant [OR (95%CI) = 0.27 (0.06, 1.19); p=0.08] with low among-study heterogeneity (I2=0%).

Conclusions: This meta-analysis did not find a significant difference in urinary tract infection rates between DBWC and SUFD in patients undergoing total pelvic exenteration. Further clinical studies will be required to further understand the pros and cons of these procedures.
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November 2019

A Multicenter Study Evaluating Natural Orifice Specimen Extraction Surgery for Rectal Cancer.

J Surg Res 2019 11 20;243:236-241. Epub 2019 Jun 20.

Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Background: Low anterior resections are increasingly performed laparoscopically for rectal cancer. Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without additional incisions or extensions. In this study, we aimed to evaluate the safety and feasibility of NOSES by comparing the short-term outcomes with those of conventional laparoscopic resection (CLR) in a multicenter retrospective study from China and Russia.

Methods: The retrospective multicenter study was conducted at three centers between January 2015 and December 2017. Relevant collected data included patient demographics, operative parameters, and postoperative complications. All procedures were performed using either a NOSES or a CLR approach.

Results: The data of a total of 768 consecutive patients with rectal cancer were retrospectively analyzed, including 412 CLR and 356 NOSES cases. The two groups were comparable for all demographics and characteristics except for the median tumor size (P = 0.038). No difference was found in the operative time and number of retrieved lymph nodes. Intraoperative complications and positive resection margins were nil in both groups. No difference was found in the time to first flatus (P = 0.150), time to first defecation (P = 0.084), length of postoperative hospital stay (P = 0.152), anastomotic leakage (P = 0.377), and intra-abdominal abscess (P = NA). The CLR group but not the NOSES group had incisional hernia or wound infection events, although the difference between groups was not significant (P = 0.253).

Conclusions: The NOSES procedure is a well-established strategy and may be considered as an alternative procedure to CLR for rectal cancer. However, the long-term benefits of this approach require further evaluation.
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http://dx.doi.org/10.1016/j.jss.2019.05.034DOI Listing
November 2019

Uni-center, patient-blinded, randomized, 12-month, parallel group, noninferiority study to compare outcomes of 3-row vs 2-row circular staplers for colorectal anastomosis formation after low anterior resection for rectal cancer.

Medicine (Baltimore) 2019 Jun;98(24):e15978

Department of Surgery, Faculty of Preventive Medicine, Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, Moscow, Russian Federation.

Background: Colorectal anastomotic leakage (AL) is one of the most serious complications in rectal cancer surgery due to its negative impact on the overall as well as cancer-specific survival. Two-row stapling technique has become standard in low anterior resections (LARs), but has neither alleviated the morbidity, nor reduced the incidence of AL. This is the 1st study that aims to compare the success rate of new 3-row circular staplers compared to that of conventional 2-row staplers in a prospective, randomized clinical trial.

Methods: The THREESTAPLER trial (Clinical Trials NCT03910699) is a prospective, noninferiority, 2-armed, parallel-group, patient and outcomes assessor blinded study with a 1:1 allocation ratio. Colorectal anastomosis will be formed using Ethicon 29 mm Curved Intraluminal Stapler (CDH29A) in the active comparator group, and using Mirus Disposable Circular Stapler 3 Row 29 (MCS-29R3) in the experimental group. The hypothesis states that the incidence of AL in the 3-row stapler group is at least not higher than in the 2-row stapler group. Assuming there is a difference in success rate of 12% and noninferiority margin Δ = 5%, 154 patients will be required to achieve statistical significance. An interim analysis will be performed after recruitment of 20 patients per group to assess safety profile of 3-row circular staplers. The primary endpoint is the rate of AL, documented by imaging studies, assessed with Pearson Chi-squared test and Fisher exact test. The secondary outcomes include severity of AL (A, B, or C), anastomotic bleeding, postoperative complication rate graded with the Clavien-Dindo classification, reintervention rate, stapler dysfunction rate, complications of defunctioning stoma, overall and cancer-specific quality of life, assessed with short form (36) and quality-of-life questionnaire core 30 questionnaires, respectively, fecal incontinence assessed with Cleveland clinic incontinence score form, and manifestation of LAR syndrome. All patients will be monitored for 12 months following the LAR.

Discussion: This is the 1st prospective randomized trial to assess the safety profile of 3-row staplers for colorectal anastomosis after LAR for rectal cancer. It may provide evidence of feasibility of 3-row circular staplers in LAR with respect to short-term and long-term patient outcomes.

Trial Registration: NCT03910699 on 10 April 2019.
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http://dx.doi.org/10.1097/MD.0000000000015978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587660PMC
June 2019

Transperineal Excision of Rectal Gastrointestinal Stromal Tumor.

Surg Technol Int 2019 May;34:195-198

Sechenov First Moscow State Medical University, Moscow, Russia.

Gastrointestinal stromal tumors (GIST) of the rectum occur in approximately 4% of patients with rectal malignancies. Herein, we demonstrate a transperineal approach as a safe surgical technique for GISTs located anterior to the rectum. The proposed technique allows safe and effective excision of a tumor without disturbing the rectal anterior wall. Unlike previous techniques, this method stresses the importance of accurate preoperative assessment and use of the surgeon's finger in the rectum to facilitate rectal wall preservation.
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May 2019

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

Gastroenterol Rep (Oxf) 2019 Feb 23;7(1):24-31. Epub 2019 Jan 23.

Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.
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http://dx.doi.org/10.1093/gastro/goy055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375350PMC
February 2019

A Giant With Clay Feet.

Ann Surg 2017 12;266(6):e110-e111

State University of New York, Stony Brook, New York, NY.

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http://dx.doi.org/10.1097/SLA.0000000000001933DOI Listing
December 2017
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