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

{"article_title":"St.Gallen consensus on safe implementation of transanal total mesorectal excision.","author":"Adamina M, Buchs NC, Penna M, Hompes R","journal_title":"Surgical endoscopy","issn":"1432-2218","isbn":"","publication_date":"2018-03-01","volume":"32","issue":"3","first_page":"1091","page_count":"","accession_number":"29234940","doi":"","publisher":"Springer","doctype":"Journal Article","subjects":"Mesocolon surgery; Patient Safety; Rectal Neoplasms surgery; Rectum surgery; Transanal Endoscopic Surgery adverse effects; Transanal Endoscopic Surgery methods; Consensus; Humans","interest_area":["Gastroenterology"," Surgery"],"abstract":"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.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=29234940","isPdfLink":true,"isSAML":false,"an":"29234940","number_other":"","type_pub":"","issn_electronic":"1432-2218","languages":"English","language":"eng","date_entry":"","date_update":"","titleSource":"Surgical endoscopy [Surg Endosc] 2018 Mar; Vol. 32 (3), pp. 1091-1103. Date of Electronic Publication: 2017 Dec 12.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2018-03-01","description":"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.<br \/>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.<br \/>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.<br \/>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.","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=29234940&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"Adamina M, Buchs NC, Penna M, Hompes R","header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"29234940","RelevancyScore":"830","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"830.146728515625"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=29234940&authtype=shib&custid=ns346513&group=main&profile=eds","physicalDescription":{"Pagination":{"StartPage":"1091"}},"additionalInfo":{"Authored_By":"Adamina M, Buchs NC, Penna M, Hompes R","Corporate_Authors":"St.Gallen Colorectal Consensus Expert Group","Journal_Info":"Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc","Publication_Type":"Journal Article; Practice Guideline","Published_Date":"2018-03-01","Source":"Surgical endoscopy [Surg Endosc] 2018 Mar; Vol. 32 (3), pp. 1091-1103. Date of Electronic Publication: 2017 Dec 12.","Languages":"English","Electronic_ISSN":"1432-2218","MeSH_Terms":"Patient Safety* , Transanal Endoscopic Surgery*\/adverse effects , Transanal Endoscopic Surgery*\/methods, Mesocolon\/*surgery , Rectal Neoplasms\/*surgery , Rectum\/*surgery, Consensus ; Humans","Subjects":"Consensus, Humans, Mesocolon surgery, Patient Safety, Rectal Neoplasms surgery, Rectum surgery, Transanal Endoscopic Surgery adverse effects, Transanal Endoscopic Surgery methods","Title_Abbreviations":"Surgical endoscopy","Volume":"32"}}