Laparoscopic Assisted Transanal Total Mesorectal Excision for Rectal Cancer in Low Site

Study Overview
=================
Brief Summary
-----------------
At present, surgical resection is still the main treatment for the potential cure of rectal cancer. Total mesorectal excision (TME) is the gold standard. The traditional laparoscopic or open surgery for some special patients is really difficult, especially for male, prostate hypertrophy, obesity, low tumor and pelvic stenosis patients to expose the gap around the mesorectum and separate to the pelvic floor. While transanal total mesorectal excision (TaTME) approach could be more directly separate the low mesorectum and relatively simple to complete distal rectal transection, which would bring some considerable advantages. Although active learning from abroad, laparoscopic assisted TaTME surgery is now in its infancy in China. It is urgent for clinical studies to obtain the results in China. This multicenter, observational study will help to encourage research in this field and to obtain data on the safety and efficacy of this procedure in Chinese patients with rectal cancer.

Official Title
-----------------
Laparoscopic Assisted transAnal Total Mesorectal Excision for Rectal cAncer in Low Site :A Prospective,Multi-center, Patients Registry Trial in China (LATERAL Trial)

Conditions
-----------------
Rectal Cancer

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: adenocarcinoma of the rectum by biopsy the lower edge of the tumor from the anal margin less than 10cm according to MRI or rigid endoscopy tumor diameter less than 4cm baseline clinical stage I-III: cT1-3 N0-2 M0 (AJCC v7) tolerable to surgery be able to understand and willing to participate in this trial with signature Exclusion Criteria: history of malignant colorectal neoplasia recent diagnosis with other malignancies patients requiring emergency surgery such as obstruction，perforation and bleeding tumor involving adjacent organs, anal sphincter, or levator ani muscle muti-focal colorectal cancer preoperative poor anal function, anal stenosis, anal injury, or fecal incontinence history of inflammatory bowel disease or familial adenomatous polyposis participating in other clinical trails can not tolerate the surgery history of serious mental illness pregnancy or lactating women preoperative uncontrolled infection the researchers believe the patients should not enrolled in

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Positive rate of circumferential resection margin (CRM) of the specimens | Circumferential resection margin (CRM) is the distance between the deepest point of tumor in the primary cancer and the margin of resection in the retroperitoneum or mesentery by pathological examination. CRM 0-1mm is defined as positive, while >1mm is negative. | 10 days after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The grade score of the specimens integrity | shows the quality of the specimens: grade 1 is bad gross specimen which means incomplete mesorectum and pelvic fascia, and muscle layer can be see >5mm; grade 3 is high quality gross specimen, which means the specimen is cylindrical, mesorectum and pelvic fascia are complete; grade 2 is between 1and 3. | 10 days after surgery | 
| The distance between lower tumor margin and the lower reaction margin | shows the oncological safety of the surgery by pathological examination. Reports should contain the distance between lower tumor margin and the lower reaction margin. | 10 days after surgery | 
| local recurrence rate | show the oncological efficacy by 3-year follow-up according to the NCCN guideline. Participants should report every follow-up examinations which prove tumor recurrence and/or metastasis or not. | 3 years after surgery | 
| the operative time | preoperative safety containing operation information, complication information. | 30 days after surgery | 
| postoperative hospital stay | recovery information. | 3 year after surgery | 
| the score of postoperative life | quality of life contains two scales: Wexner scale and EORTC QLQ-CR29 scale, which show quality of life and the anal function. | 6 months after surgery | 
| disease free survival rate | show the oncological efficacy by 3-year follow-up according to the NCCN guideline. Participants should report every follow-up examinations which prove tumor recurrence and/or metastasis or not. | 3-year after surgery | 
| overall survival rate | show the oncological efficacy by 3-year follow-up according to the NCCN guideline. Participants should report every follow-up examinations which prove tumor recurrence and/or metastasis or not. | 3-year after surgery | 
| the rate of postoperative complications | preoperative safety containing operation information, complication information. | 30 days after surgery | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
transanal surgery, total mesorectal excision, rectal cancer