Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

Overview

Journal Ann Coloproctol

Date 2017 Mar 15

PMID 28289660

Citations 6

Authors

Audrius Dulskas

Alfredas Kilius

Kestutis Petrulis

Narimantas E Samalavicius

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM).

Methods: Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences.

Results: The average tumor size was 2.8 ± 1.5 cm (range, 0.5-8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days.

Conclusion: TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

Citing Articles

The Outcome of Local Excision of Rectal Adenomas with High-Grade Dysplasia by Transanal Endoscopic Microsurgery: A Single-Center Experience.

Khalifa M, Gingold-Belfer R, Issa N J Clin Med. 2024; 13(5).

PMID: 38592246 PMC: 10934864. DOI: 10.3390/jcm13051419.

Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal.

Serra-Aracil X, Lucas-Guerrero V, Mora-Lopez L Clin Colon Rectal Surg. 2022; 35(2):129-134.

PMID: 35237108 PMC: 8885161. DOI: 10.1055/s-0041-1742113.

Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?.

Serra-Aracil X, Campos-Serra A, Mora-Lopez L, Serra-Pla S, Pallisera-Lloveras A, Flores-Clotet R World J Surg. 2019; 44(3):939-946.

PMID: 31686162 DOI: 10.1007/s00268-019-05262-x.

Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis.

Dulskas A, Atkociunas A, Kilius A, Petrulis K, Samalavicius N Visc Med. 2019; 35(3):151-155.

PMID: 31367611 PMC: 6616047. DOI: 10.1159/000493281.

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience.

Ondhia M, Tamvakeras P, OToole P, Montazerri A, Andrews T, Farrell C Colorectal Dis. 2019; 21(10):1164-1174.

PMID: 31207005 PMC: 6900238. DOI: 10.1111/codi.14730.

References

Kumar A, Coralic J, Kelleher D, Sidani S, Kolli K, Smith L . Complications of transanal endoscopic microsurgery are rare and minor: a single institution's analysis and comparison to existing data. Dis Colon Rectum. 2013; 56(3):295-300. DOI: 10.1097/DCR.0b013e31827163f7. View

Lu J, Lin G, Qiu H, Xiao Y, Wu B, Zhou J . Comparison of Transanal Endoscopic Microsurgery and Total Mesorectal Excision in the Treatment of T1 Rectal Cancer: A Meta-Analysis. PLoS One. 2015; 10(10):e0141427. PMC: 4624726. DOI: 10.1371/journal.pone.0141427. View

Heald R, Moran B, Ryall R, Sexton R, Macfarlane J . Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998; 133(8):894-9. DOI: 10.1001/archsurg.133.8.894. View

de Graaf E, Doornebosch P, Tetteroo G, Geldof H, Hop W . Transanal endoscopic microsurgery is feasible for adenomas throughout the entire rectum: a prospective study. Dis Colon Rectum. 2009; 52(6):1107-13. DOI: 10.1007/DCR.0b013e3181a0d06d. View

de Graaf E, Burger J, van Ijsseldijk A, Tetteroo G, Dawson I, Hop W . Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis. 2010; 13(7):762-7. DOI: 10.1111/j.1463-1318.2010.02269.x. View

Blair S, Ellenhorn J . Transanal excision for low rectal cancers is curative in early-stage disease with favorable histology. Am Surg. 2000; 66(9):817-20. View

Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre M . The Global Burden of Cancer 2013. JAMA Oncol. 2015; 1(4):505-27. PMC: 4500822. DOI: 10.1001/jamaoncol.2015.0735. View

Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y . Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2011; 17(1):1-29. DOI: 10.1007/s10147-011-0315-2. View

Althumairi A, Gearhart S . Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol. 2015; 6(3):296-306. PMC: 4397248. DOI: 10.3978/j.issn.2078-6891.2015.022. View

10.

Ponz de Leon M, Di Gregorio C . Pathology of colorectal cancer. Dig Liver Dis. 2001; 33(4):372-88. DOI: 10.1016/s1590-8658(01)80095-5. View

11.

Morson B . President's address. The polyp-cancer sequence in the large bowel. Proc R Soc Med. 1974; 67(6 Pt 1):451-7. PMC: 1645739. View

12.

Guerrieri M, Baldarelli M, Morino M, Trompetto M, Da Rold A, Selmi I . Transanal endoscopic microsurgery in rectal adenomas: experience of six Italian centres. Dig Liver Dis. 2006; 38(3):202-7. DOI: 10.1016/j.dld.2005.11.014. View

13.

Moore J, Cataldo P, Osler T, Hyman N . Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum. 2008; 51(7):1026-30. DOI: 10.1007/s10350-008-9337-x. View

14.

Allaix M, Arezzo A, Caldart M, Festa F, Morino M . Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum. 2009; 52(11):1831-6. DOI: 10.1007/DCR.0b013e3181b14d2d. View

15.

Son H, Song S, Lee W, Yang S, Park S, Yang M . Characteristics of early colorectal carcinoma with lymph node metastatic disease. Hepatogastroenterology. 2008; 55(85):1293-7. View

16.

Tsai B, Finne C, Nordenstam J, Christoforidis D, Madoff R, Mellgren A . Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations. Dis Colon Rectum. 2009; 53(1):16-23. DOI: 10.1007/DCR.0b013e3181bbd6ee. View

17.

Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi B . Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis. 2003; 18(3):222-9. DOI: 10.1007/s00384-002-0441-4. View

18.

Lunevicius R, Poskus T, Samalavicius N . National burden of colorectal cancer in Lithuania and the ranking of Lithuania within the 45 European nations. Oncol Lett. 2015; 10(1):433-438. PMC: 4487151. DOI: 10.3892/ol.2015.3171. View

19.

Sajid M, Farag S, Leung P, Sains P, Miles W, Baig M . Systematic review and meta-analysis of published trials comparing the effectiveness of transanal endoscopic microsurgery and radical resection in the management of early rectal cancer. Colorectal Dis. 2013; 16(1):2-14. DOI: 10.1111/codi.12474. View

20.

Whitehouse P, Tilney H, Armitage J, Simson J . Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas. Colorectal Dis. 2006; 8(9):795-9. DOI: 10.1111/j.1463-1318.2006.01098.x. View