Transanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience

Zacharakis, Emmanouil; Freilich, Simon; Rekhraj, S.; Athanasiou, Thanos; Paraskeva, Paraskeva; Ziprin, Paul; Darzi, Ara

doi:10.1016/j.amjsurg.2007.03.005

Cited by 36 publications

(28 citation statements)

References 32 publications

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“…This fact could be explained by the diathermic damage to the remaining adenomatous tissue during dissection which causes the sterilization of the margins. A further factor associated with risk of recurrence is the size of the adenoma, with increasing risk of recurrence over time for those who have large adenomas excised [27][28][29][30][31]. In our clinical practice, a full-thickness incision of the rectal wall is always initiated at a distance of approximately 5 mm around the tumor.…”

Section: Discussionmentioning

confidence: 99%

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%

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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“…1.7 3.5 d.n.o Neary et al [24] 21 0 4.7 d.n.o Katti et al [25] 58 7 10 34 Vorobiev et al [26] 113 -8.3 29.5 Bretagnol et al [27] 148 14.9 7.6 33 Endreseth et al [28] 64 20 13 24 Zacharakis et al [29] 48 4.2 6.3 37 Schäfer et al [30] 33 18 12 36.4 Røkke et al [31] 56 10 0 12 Guerrieri et al [32] 530 -4.3 44 McCloud et al [33] 75 37.3 16 31 Whitehouse et al [34] 146 5.5 4.8 39 Platell et al [35] 62 -2.4 24 Lloyd et al [36] 68 9 5.9 28.7 Ganai et al [37] [31] did not observe adenoma recurrence after 12 mo follow-up in a series of patients in whom the residual adenoma in surgical margin was 10%.…”

Section: Followup (Mo)mentioning

confidence: 99%

Surgical resection of rectal adenoma: A rapid review

Casadesús¹

2009

WJG

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Transanal excision (TE), endoscopic transanal resection (ETAR) and transanal endoscopic microsurgery (TEM) can be used to remove adenomatous polyps. However, their use is limited by the size or location of the tumor. TE is limited to the lower rectum, TEM offers better access to lesions in the middle and upper rectum, and ETAR is used less frequently than it deserves for resection of rectal lesions.

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“…62,[87][88][89] Several groups have reported their experience with TEM in patients with early rectal cancers (Table 4). 38,39,44,45,86,[90][91][92][93][94][95][96][97][98][99] Baartrup and colleagues 86 retrospectively studied 72 patients 45 Tot a l - 97 Tot a l - Tot a l -…”

Section: Early Rectal Adenocarcinomasmentioning

confidence: 99%