Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients

Brown, C. J.; Gentles, John Quinn; Phang, Terry; Karimuddin, Ahmer; Raval, Manoj J.

doi:10.1111/codi.14337

Cited by 6 publications

(3 citation statements)

References 21 publications

(33 reference statements)

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“…Infection rates correspond to reported rates in the literature between 1% and 10%. 18,23 However, there were variations in patient selection and protocols across the included studies. Bowel preparation and prophylactic antibiotics were given in the randomised controlled trial.…”

Section: Discussionmentioning

confidence: 99%

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

Khan

Hunter

Manzoor

2020

annals

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Introduction Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open. Methods A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay. Findings Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67). Conclusion Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.

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Section: Discussionmentioning

confidence: 99%

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

Khan

Hunter

Manzoor

2020

annals

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“…The early inclusion of 2-surgeon collaboration on the novel perineal approach, combined with extensive experience with transanal endoscopic microsurgery before TaTME introduction, was important in avoiding these potentially severe complications. 24 Consistent with expert guidelines introduced in Canada and the United States, careful patient selection and formal proctored training are crucial. 5,6 As reported by Robertson et al, 25 TaTME comprised a select proportion of patients with its uptake at our institution.…”

Section: Discussionmentioning

confidence: 99%

Local Recurrence-Free Survival After TaTME: A Canadian Institutional Experience

Hershorn,

Ghuman,

Karimuddin

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Transanal total mesorectal excision is a novel surgical treatment for mid to low rectal cancers. Norwegian population data has raised concerns about local recurrence in patients treated with transanal total mesorectal excision. OBJECTIVE: Our objective was to analyze local recurrence and disease-free survival in patients treated by transanal total mesorectal excision for rectal cancer at a high-volume tertiary center. DESIGN: This is a retrospective study utilizing a prospectively maintained institutional transanal total mesorectal excision database. Patient demographics, treatment and outcomes data were analyzed. Local recurrence, disease-free, and overall survival were analyzed using Kaplan-Meier analysis. SETTINGS: The study was conducted at a single academic institution in Vancouver, Canada. PARTICIPANTS: All patients treated by transanal total mesorectal excision for rectal adenocarcinoma between 2014-2022 were included. MAIN OUTCOME MEASURES: The primary outcome was local recurrence-free survival. RESULTS: Between 2014 and 2022, 306 patients were treated by transanal total mesorectal excision at St. Paul’s Hospital. Of these, 279 patients met inclusion criteria. Mean age was 62 years (SD ± 12.3) and 66.7% of patients were male. Restorative resection was achieved in 97.5% of patients with a conversion rate from laparoscopic to open of 6.8%. Composite optimal pathological outcome was 93.9%. The median follow-up was 26 months (interquartile range 12 – 47) and 82.8% achieved reestablishment of gastrointestinal continuity to date. The overall local recurrence rate was 4.7% (n = 13). The estimated 2-year local recurrence-free survival was 95.0% (95% CI: 92 - 98) and 94.5% at 5 years (95% CI: 91 – 98). LIMITATIONS: Limitations include retrospective nature of the study and generalizability of a Canadian population. CONCLUSIONS: Recent European data has challenged the presumed oncologic safety of transanal total mesorectal excision. While the learning curve for this procedure is challenging and poor outcomes are associated with low volume, this high volume single-center study confirms acceptable oncologic outcomes consistent with the current standard. See Video

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“…For "difficult", endoscopically unresectable rectal polyps, transanal excision is the method of choice. It has been shown that transanal endoscopic microsurgery and transanal minimally invasive surgery are effective techniques for the surgical removal of these polyps [46,47].…”

Section: Endoscopic Mucosal Resectionmentioning

confidence: 99%

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

Herszényi¹

2018

Dig Dis

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Background: Colonoscopy is the gold standard for adenoma detection. All endoscopists who perform colonoscopy must by mandate be skilled to perform polypectomy. However, there are significant differences between endoscopists in terms of the polyp detection rate and in the effectiveness of polypectomy. Summary: Most polyps identified can be managed by conventional polypectomy and do not pose a significant challenge for resection to an adequately skilled and trained endoscopist. Up to 15% of polyps may be considered “difficult”, unsuitable for conventional endoscopic removal because of size, morphology, site, or access grade. Endoscopist-, patient- and polyp-specific viewpoints influence the management of difficult polyps. Advances in endoscopic resection techniques have led to extended indications for polypectomy. Conventional endoscopic removal of colorectal polyps is associated with a small but not negligible incidence of complications, most commonly bleeding and perforation. Advanced techniques for difficult polyps can potentially cause significant, even life-threatening complications. In addition, in the presence of “difficult” polyps, complications are more common. Key Messages: Multiple techniques are now available for the resection of difficult polyps. The endoscopist should individualize the appropriate approach for the treatment of difficult polyp in order to maximize oncological safety, efficacy and minimize complications and unnecessary surgery.

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Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients

Abstract: Outpatient TEM is safe and carries a low risk of readmission. In centres with an outpatient TEM strategy, predictors of hospital admission include proximal tumours, prolonged surgical time and open management of the surgical defect.

Cited by 6 publications

References 21 publications

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

Local Recurrence-Free Survival After TaTME: A Canadian Institutional Experience

The “Difficult” Colorectal Polyps and Adenomas: Practical Aspects

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