Long-term functional results and quality of life after transanal endoscopic microsurgery

Allaix, Marco Ettore; Rebecchi, Fabrizio; Giaccone, Claudio; Mistrangelo, Massimiliano; Morino, Mario

doi:10.1002/bjs.7584

Cited by 150 publications

(84 citation statements)

References 34 publications

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“…In fact, transanal surgery with retractors is associated with a consistent incidence of recurrence, especially for tumors of the upper and midrectum [12,13]. TEM combines a less invasive transanal approach with the benefits of better postoperative functional outcome and quality of life [17] and low recurrence rates for adenomas and selected early rectal cancers, thanks to enhanced visualization of the surgical field which allows more precise dissection [25]. No studies as of yet have compared piecemeal endoscopic techniques with TEM for large rectal adenomas.…”

Section: Discussionmentioning

confidence: 99%

“…While transanal local excision allows comfortable access only to the distal rectum, which explains in part the high rates of local recurrence [12,13], transanal endoscopic microsurgery (TEM), proposed almost 30 years ago by Buess [14,15], has the advantages of minimally invasive local treatment [16,17], allowing large full-thickness local resection under improved visualization conditions. The aim of this study was to identify risk factors associated with local recurrence after TEM for treating large sessile rectal adenomas.…”

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Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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Background Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a "tailored" approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma. Methods This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated. Results Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12-216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4-33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003). Conclusions TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence. Keywords Transanal endoscopic microsurgery Rectal adenoma Recurrence Risk factors Rectal cancer is a common disease in Western countries, with increased incidence in the elderly, males, and obese people [1,2]. Dysplasia precedes the occurrence of invasive rectal cancer [3,4]. Endoscopic detection and removal of rectal adenomas prevents the development of rectal cancer, significantly contributing to the "cure" of the disease [5,6]. Complete resection of the precancerous lesion is mandatory to prevent recurrence. However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.

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Section: Discussionmentioning

confidence: 99%

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Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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“…Resection of rectum by conventional surgery, in case of unfavourable pathology after TEM, is an option used in our institute successfully. TEM has been shown not to have any long-term effect on anorectal function or quality of life (QOL) [18,19]. The ageing population in the UK is presenting us with management dilemmas for early rectal cancer when conventional surgical resection has been shown to have significantly higher risks of post-operative morbidity and mortality in the elderly [20].…”

Section: Discussionmentioning

confidence: 99%

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

et al. 2014

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Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71±10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66±20 mm (range 33-120 mm) with a mean polyp size of 41±24 mm (range 18-110 mm). The mean cancer size was 24±13 mm (range 2-50 mm). Average distance from the anal verge was 70 ±37 mm (range 10-150 mm), and the mean operating time was 72±22 min (range 40-120 min), with an average blood loss of 28±15 ml (range 10-50ml). Median hospital stay was 2±1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13±11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.

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“…It was demonstrated by endorectal ultrasound that partial lesions of the internal anal sphincter can occur in up to 29% of patients 1 . Other studies have shown no significant changes in incontinence scores or in quality of life questionnaires in the long term evaluation 21,22 . Despite the fact that our patients were not submitted to sphincter evaluation with ultrasound, no anal incontinence was referred in this initial experience.…”

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

Filho¹,

Costa²,

Guerra³

2012

J. Coloproctol. (Rio J.)

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Alves Filho EF, Costa PFO, Guerra JC. Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study. J Coloproctol, 2012;32(4): 402-406. ABSTRACT:Transanal endoscopic microsurgery (TEM) has been used since the 1980's for the treatment of selected rectal cancers, with clear benefits regarding morbidity and mortality, and good oncological outcomes when compared to radical surgery and conventional local resections. The high cost of equipment and the need for long learning curve did not allow the spread of the technique. The aim of this study was to describe the technical characteristics and outcomes of 4 patients operated by this technique, 3 with histologically confirmed adenomas and 1 carcinoid rectal tumor, with no recurrence after an average follow-up of 12 months. The use of single port devices for transanal surgery is a safe method with good oncological results and allows a faster learning curve, by the similarity with conventional laparoscopic procedures and the availability of devices commonly used in laparoscopy. Keywords: colorectal surgery; rectal neoplasms; TAMIS; laparoscopy.ReSumo: A microcirurgia endoscópica transanal (TEM) é usada desde a década de 80 para o tratamento de neoplasias retais selecionadas, com claros benefícios relacionados à mortalidade e morbidade, e com bons resultados oncológicos, em comparação à cirurgia radical e a ressecções locais convencionais. O custo alto de equipamento de TEM e a necessidade de uma curva de aprendizagem longa ainda não permitiram a propagação da técnica. O objetivo deste estudo foi descrever a técnica cirúrgica e os desfechos oncológicos em 4 pacientes operados por esta técnica, 3 com diagnóstico final de adenomas e 1 de tumor carcinoide, sem recorrência após seguimento médio de 12 meses. A utilização de dispositivos de portal único para a cirurgia transanal é um método seguro e com bons resultados oncológicos, permitindo uma curva de aprendizado mais rápida pela semelhança com os procedimentos laparoscó-picos convencionais e pela disponibilidade de dispositivos comumente utilizados em laparoscopia.Palavras-chave: cirurgia colorretal; neoplasias retais; TAMIS; laparoscopia.

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Long-term functional results and quality of life after transanal endoscopic microsurgery

Abstract: TEM had no long-term effect on anorectal function or QoL. Lower anal resting pressure at early follow-up was not associated with defaecation problems in patients who were continent before surgery.

Cited by 150 publications

References 34 publications

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

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