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Laparoscopic Anterior Resection and Total Mesorectal Excision for Rectosigmoid Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Avanish Saklani, S Barath Raj Kumar, Sanket Bankar
TME is the standard of care in removing perirectal tissue when performing surgery of the rectum for an oncological cause. Rectal cancer surgery can be performed using either an open or minimally invasive approach. No one approach has been shown to be superior to the other. With the current emphasis on enhanced recovery after surgery (ERAS), laparoscopic rectal surgery will complement the early recovery of the patient.
Anatomy
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Reza Mirnezami, Alex H. Mirnezami
The rectum is surrounded by a layer of perirectal fat, which is generally more abundant posteriorly and has a characteristic bi-lobed appearance when resected in the correct plane. These two ‘lobes’ are a result of the paired concavities crated by the levator muscles. Within this perirectal fat lie the perirectal lymph nodes and the superior rectal vessels. This perirectal fat is in turn surrounded by a distinct circumferential fascial layer called the fascia propria of the rectum. Collectively this envelope of tissue is known as the mesorectum. The technique of total mesorectal excision (TME), popularised by Heald, refers to the precise dissection of the rectum and accompanying lympho-vasculature to deliver an oncologically superior specimen, within an intact mesorectal envelope.
Colorectal
Published in Stephen Brennan, FRCS General Surgery Viva Topics and Revision Notes, 2017
The superior third of the rectum is covered by peritoneum over its anterior and lateral surfaces. The Total Mesorectal Excision (TME) is the surgical plane between the fascia propria of the rectum and the parietal fascia. The mesorectum is an extension inferiorly from the mesosigmoid. It contains the terminal and proximal branches of the IMA and IMV and lymphatics glands.
Targeting the Tumor-Tumor Microenvironment Crosstalk
Published in Expert Opinion on Therapeutic Targets, 2023
Sunil S. Badve, Yesim Gökmen-Polar
A quote attributed often to Napoleon Bonaparte posits that the ‘army marches on its stomach.’ The same can be said to be true regarding tumors. Epithelium, from which most cancers arise, contains no means of sustenance, and derives all its nourishment from diffusion of nutrients from the surrounding stromal tissue. This process is retained in cancers and serves to highlight the importance of TME. Rudolf Virchow had identified the relationship between cancer and inflammation in 1863 and had proposed the concept of cancer as a non-healing wound [1]. However, multiple successive generations of investigators got mesmerized by the ‘ugly beauty’ of the tumor cells and focused almost entirely on the cancer cells. The resurgence of studies in the tumor support system, the tumor microenvironment, has been slow. It has accelerated in the last decade or so following the landmark publication of the Hallmarks of cancer in 2011 [2]. The tumors are highly complex and heterogeneous due to their dynamic interaction with their tumor microenvironment (TME). The processes within tumors leading to hallmarks of cancers including proliferation, migration, and escape from immune surveillance result from the dynamic interaction of tumor epithelial cells with other cell types within the tumor microenvironment leading to their adaption and ultimate survival in an unfamiliar environment [3]. Modifying the TME as a therapeutic strategy is clearly a viable proposition.
Outcomes after the watch-and-wait strategy and local excision treatment for rectal cancer: a meta-analysis
Published in Expert Review of Anticancer Therapy, 2023
Jinghui Li, Yongli Ma, Liang Wen, Guosheng Zhang, Xueqing Yao
3) Preoperative chemoradiotherapy regimen. A multicenter randomized trial (TREC) found that the occurrence of serious adverse events and the risk of tumor recurrence in the organ preservation group, which received transanal endoscopic microsurgery after 8–10 weeks after short-course radiotherapy, was significantly lower than the TME group (P = 0.04 and P = 0.03, respectively) in patients with early-stage rectal cancer [38]. The results of that study showed that anal endoscopic microsurgery after short-course radiotherapy resulted in high-quality organ preservation compared to TME; however, fewer randomly assigned patients were included in the study. Large-scale randomized controlled trials such as STAR-TREC are still needed to address the problem of preoperative chemoradiotherapy regimens for organ preservation: is short-range radiotherapy superior to long-range radiotherapy [39]? Is nCRT superior to TNT, immunotherapy, or immunization therapy combined with chemoradiotherapy [40–43]? Additionally, how should the best course be implemented? Can it be widely used across primary medical settings [44]?
Self-assembling peptides-based nano-cargos for targeted chemotherapy and immunotherapy of tumors: recent developments, challenges, and future perspectives
Published in Drug Delivery, 2022
Xue-Jun Wang, Jian Cheng, Le-Yi Zhang, Jun-Gang Zhang
Peptide-based DDSs that can be self-assembled are being used in cancer diagnostics and treatment. To achieve high selectivity and specificity, nanomedicines are being functionalized to target tumors and minimize systemic toxicity. TME has a significant impact on the efficacy of cancer therapy. Cancer nanomedicine's behavior is governed by the TME. Cancer nanomedicine research, particularly self-assembled peptide hydrogels, has resulted in numerous improvements in cancer diagnosis and treatment. The focus of nanotherapeutics is expected to expand in the coming years as more medical concerns such as organ toxicity and relapse become apparent. Nanocarriers will provide additional benefits to cancer therapies because of their flexible structure and design of nanomaterials. Due to their chain lengths and unique sequences, self-assembled peptides form organized network structures such as hydrogels. They possess high sensitivity toward TME. Despite the numerous advantages, some challenges remain that should be addressed in the future for SAPs against malignant tumors.