Indications for performing transanal endoscopic microsurgery (TEM) in rectal cancer patients

Ikeda, Kazuhiro; Mori, Taketoshi; Abé,; Koyanagi,; Akahoshi,; Sugimachi,

doi:10.1046/j.1463-1318.2000.00131.x

Cited by 3 publications

(5 citation statements)

References 41 publications

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“…For rectal tumors, correct definition of the lesion's extension may avoid unnecessary major surgery and demolitive treatment [3,8,9,16]. On the other hand, attention must be given to avoid risky undertreatment.…”

Section: Discussionmentioning

confidence: 99%

“…Its role in identifying cases suitable for local excision has been validated [3,8,14,[18][19][20]. ERUS depicts anatomic layers of the rectal wall with a high degree of accuracy and thus enables precise determination of the tumor extent in relation to the different wall layers.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, reported accuracy rates of endorectal ultrasound in assessing the T stage are in the range 69-97% [3,8,21].…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of transanal endoscopic microsurgery (TEM) [6, 7], a relatively new technique that permits excision of rectal neoplasms up to 20 cm from the anal verge [8], has extended the possibility of conservative treatment to tumors located in the mid and upper rectum, and at the same time has allowed more precise excision with consequent reduction in local recurrence rates [9][10][11].…”

Section: Local Excision (Le) Is a Validated Treatment Modality Both Fmentioning

confidence: 99%

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Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings

et al. 2009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Overall, reported accuracy rates of endorectal ultrasound in assessing the T stage are in the range 69-97% [3,8,21].…”

Section: Discussionmentioning

confidence: 99%

Section: Local Excision (Le) Is a Validated Treatment Modality Both Fmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings

et al. 2009

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“…[20][21][22] On the other hand, radical surgery for rectal neoplasms leads to complications in 20%-40% of cases and up to 80% of patients experience altered gastointestinal, sexual and urinary function. 23,24 The main advantages of TEM include the possibility of excising rectal neoplasms up to 20 cm from the anal verge 25 and more precise excision with consequent reductions in local recurrences rates. 17,26,27 However, for cancer invading the muscularis propria (T2 or more), TEM resection is associated with high rates of recurrence and these patients should be offered more than TEM alone.…”

Section: Discussionmentioning

confidence: 99%

Transanal endoscopic microsurgery for rectal villous tumours: Can we rely solely on preoperative biopsies and the surgeon’s experience?

Letarte

Drolet

Laliberte

et al. 2019

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Background: Transanal endoscopic microsurgery has become the standard of treatment for rectal villous adenomas. However, the role of preoperative imaging for these lesions is not clear. The aim of this study was to compare the value of preoperative imaging and surgeon clinical staging in the preoperative evaluation of patients with rectal villous adenomas having transanal endoscopic microsurgery resection. Methods: We conducted a single-centre comparative retrospective cohort study of patients who underwent transanal endoscopic microsurgery surgery for rectal villous adenomas from 2011 to 2013. The intervention was preoperative imaging versus surgeon clinical staging. The primary outcome was the accuracy of clinical staging by preoperative imaging and surgeon clinical staging according to the histopathologic staging. Results: A total of 146 patients underwent transanal endoscopic microsurgery surgery for rectal villous adenomas. One hundred and twelve (76.7%) of those patients had no preoperative imaging while 34 patients (23.3%) had either endorectal ultrasound (22 patients) or magnetic resonance imaging (12 patients). Surgeon staging was accurate in 89.3% of cases whereas staging by endorectal ultrasound was accurate in 40.9% cases and magnetic resonance imaging was accurate in 0% of cases. In the imaging group, inaccurate staging would have led to unnecessary radical surgery in 44.0% of patients. Conclusion: This study was subject to selection bias because of its retrospective nature and the limited number of patients with imaging. Patients with rectal villous tumours without invasive carcinoma on biopsies and without malignant characteristics on appearance in the judgment of an experienced colorectal surgeon might not benefit from preoperative imaging before undergoing transanal endoscopic microsurgery procedures. Contexte : La microchirurgie endoscopique transanale est devenue le traitement standard des adénomes villeux rectaux. La valeur de l'imagerie préopératoire pour le traitement de ces lésions n'est toutefois pas bien établie. Cette étude visait à comparer l'exactitude de la stadification par imagerie préopératoire et de la stadification clinique par le chirurgien dans le cadre de l'évaluation préopératoire des patients atteints d'adénomes villeux rectaux qui subissent une résection par microchirurgie endo scopique transanale.

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A new proctoscope for transanal endoscopic operations

Rocha

Féres

2008

Tech Coloproctol

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Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.

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Indications for performing transanal endoscopic microsurgery (TEM) in rectal cancer patients

Abstract: Since some patients with a preoperative evaluation of T2 rectal cancer showed the possibility of a complete cure with a local excision, preoperative T2 stage rectal cancer is considered to be a good candidate for a local excision using TEM.

Cited by 3 publications

References 41 publications

Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings

Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings

Transanal endoscopic microsurgery for rectal villous tumours: Can we rely solely on preoperative biopsies and the surgeon’s experience?

A new proctoscope for transanal endoscopic operations

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