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Background: Technological developments have allowed advances in minimally invasive techniques for total mesorectal excision such as laparoscopy, robotics, and transanal surgery. There remains an ongoing debate about the safety, benefits, and appropriate clinical scenarios for which each technique is employed. The aim of this study was to provide a panel of expert opinion on the role of each surgical technique currently available in the management of rectal cancer using a modified Delphi method. Methods: Surveys were designed to explore the key patient- and tumor-related factors including clinical scenarios for determining a surgeon's choice of surgical technique. Results: Open surgery was favoured in obese patients with an extra-peritoneal tumor and a positive circumferential resection margin (CRM) or T4 tumor when a restorative resection was planned. Laparoscopy was favoured in non-obese males and females, in both intra- and extra-peritoneal tumors with a clear CRM. Robotic surgery was most commonly offered to obese patients when the CRM was clear and if an abdominoperineal resection was planned. Transanal total mesorectal excision (taTME) was preferred in male patients with a mid or low rectal cancer, particularly when obese. Transanal endoscopic microsurgery/transanal minimally invasive surgery local excision was only offered to frail patients with small, early stage tumors. Conclusions: All surgical techniques for rectal cancer dissection have a role and may be considered appropriate. Some techniques have advantages over others in certain clinical situations, and the best outcomes may be achieved by considering all options before applying an individualised approach to each clinical situation. [ABSTRACT FROM AUTHOR]

Background Young patients with colorectal cancer pose diagnostic and management challenges. The study aim was to assess colorectal surgical practice in Australia and New Zealand with respect to management of young patients with colorectal cancer and the impact of family history. Methods An electronic survey was sent to members of the Colorectal Surgical Society of Australia and New Zealand ( CSSANZ). The survey assessed the clinical practice of the respondent and utilized scenario-based questions to investigate their clinical approach to patients under 50 years who develop colorectal cancer with respect to management and surveillance. Colorectal society trainees, members and fellows were also questioned on a scenario of polyposis and no vertical transmission, and which operation they would perform. Results Of the 189 surveys sent out, 114 respondents completed the survey (60.3%) with 99 (86.8%) respondents practicing colorectal surgeons and 13.2% (15) CSSANZ trainees. Ninety-five percent of respondents had a practice with greater than 70% colorectal work. Of the surgeons and trainees, 92.1% (105) would perform a limited resection in a young patient with a right-sided cancer. Six percent altered the approach if there was a first-degree relative with colorectal cancer, and 68% altered the approach if the family history fulfilled criteria for hereditary non-polyposis colorectal cancer. Only 22.8% of respondents could recognize potential MutYH-associated polyposis with moderate polyposis and absence of vertical transmission. Discussion Colorectal surgeons in Australia will modify their management of patients under 50 years with colorectal cancer based on a family history and risk of inherited colorectal cancer syndromes. Further education could improve management. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the use of a pathway for the introduction of transanal total mesorectal excision (taTME) into Australia and New Zealand., Method: A pathway for surgeons with an appropriate level of specialist training and baseline skill set was initiated amongst colorectal surgeons; it includes an intensive course, a series of proctored cases and ongoing contribution to audit. Data were collected for patients who had taTME, for benign and malignant conditions, undertaken by the initial adopters of the technique., Results: A total of 133 taTME procedures were performed following the introduction of a training pathway in March 2015. The indication was rectal cancer in 84% of cases. There was one technique-specific visceral injury, which occurred prior to that surgeon completing the pathway. There were no cases of postoperative mortality; morbidity occurred in 27.1%. The distal resection margin was clear in all cases of rectal cancer, and the circumferential resection margin was positive in two cases. An intact or nearly intact total mesorectal excision was obtained in more than 98% of cases., Conclusion: This study demonstrates the safe and controlled introduction of a new surgical technique in a defined surgeon population with the use of a pathway for training. The authors recommend a similar pathway to facilitate the introduction of taTME to colorectal surgical practice., (Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.)