Transanal endoscopic microsurgery in early rectal cancer: time for a trial?

Suppiah, Aravind; Maslekar, S.; Alabi, Andrew; Hartley, John E.; Monson, J. R. T.

doi:10.1111/j.1463-1318.2007.01448.x

Cited by 66 publications

(54 citation statements)

References 59 publications

(75 reference statements)

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“…The role of TEM in the treatment of adenocarcinoma is controversial. [13][14][15][16][17] Generally, TEM has been used for adenomas not amenable to endoscopic or transanal excision, for T1N0 rectal carcinomas in patients who accept a higher risk of local recurrence to avoid radical rectal resection, and for palliative resection for more advanced lesions in medically unfit patients.…”

Section: Discussionmentioning

confidence: 99%

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Planting

Phang²,

Raval³

et al. 2013

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Background: Anal dilation during tumour excision with transanal endoscopic microsurgery (TEM) has caused concerns regarding postoperative anal function. We sought to determine whether TEM affects anorectal function and quality of life. Results: Forty patients received TEM; 30 of them met all inclusion criteria and agreed to participate. The median age was 70 (42-93) years, and median follow-up time between the interview and the operation was 365 (55-712) days. Tumours excised included 19 adenomas, 8 carcinomas and 3 carcinoid tumours. The median distance from the tumour to the anal verge was 6.5 (2-13) cm. Median length of stay was 1 (0-12) day. For most aspects of quality of life, there were no detectable differences after surgery. The EORTC QLQ-C30 showed a significant improvement in diarrhea (27.8 v. 10, p = 0.002). The FIQL scores improved with surgery (3.59 v. 3.85, p = 0.020). There was no difference in pre-versus postoperative FISI scores (6.7 v. 6.3, p = 0.93). Methods Conclusion:Despite a large operating rectoscope, TEM improves quality of life related to fecal incontinence and does not have a negative impact on fecal continence.Contexte : La dilatation de l'anus au cours de l'excision d'une tumeur par microchirurgie endoscopique transanale (MET) soulève des préoccupations quant à la fonction anale postopératoire. Nous avons cherché à déterminer si la MET a un effet sur la fonction anorectale et la qualité de vie.

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Section: Discussionmentioning

confidence: 99%

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Planting

Phang²,

Raval³

et al. 2013

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“…A full-thickness LE can be proposed as a curative surgical procedure only for the treatment of adenomas and selected T1 rectal cancers [81,82]. There is increasing evidence that this approach can be offered also to patients with intraperitoneal rectal cancers, with no increased morbidity and cancer-related mortality [83][84][85][86][87][88].…”

Section: Qualitative Risk Factors and New Biomarkersmentioning

confidence: 99%

“…The depth of submucosal invasion represents one of the most important risk factors for local recurrence and poor survival in patients undergoing LE for ERC [5,77,78,81,82,97,98,100]. One of the main limitations of the preoperative staging is the identification of T1 sm1 rectal cancers [106][107][108].…”

Section: Qualitative Risk Factors and New Biomarkersmentioning

confidence: 99%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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“…Probablemente el hecho que el diseño y longitud del dispositivo le ha permitido ajustarse de forma ideal al canal anal, no ocasionando mayor trauma y a diferencia del TEM (en los que sí existen series que describen alteraciones funcionales post-procedimiento), TAMIS no se ha asociado a incontinencia anal a corto plazo 18 . Las tasas de complicaciones tras la cirugía transanal han sido bien documentadas y promedian un 4% en series retrospectivas 14,19,[20][21] . Dentro de ellas, la hemorragia, la dehiscencia de la línea de sutura, formación de abscesos, incontinencia anal esporádica y la estenosis son las más comunes.…”

Section: Discussionunclassified

Cirugía Transanal Por Puerto Único Para La Resección Local De Lesiones De Recto

Sch

et al. 2014

Rev Chil Cir

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Single port transanal excision for local treatment of rectal lesionsBackground: Since 2009, transanal minimally invasive surgery (TAMIS) is increasingly used as an alternative to local excision and transanal microscopic excision (TEM) for rectal lesions located in the mid and superior third. The clinical benefits of the technique are being evaluated. Aim: To establish the feasibility, quality of excision and short term results of single port transanal excision for rectal lesions. Patients and Methods: Analysis of a prospective series of patients subjected to single port transanal excision. Patients had benign or malignant lesions located in the mid or superior third of the rectum. Those with a diagnosis of adenocarcinoma were excluded. Results: The transanal resection using the SILS Port ® was completed in 11 patients aged 21 to 86 years (eight women). The American Society of Anesthesiologists (ASA) classification of patients was two and their body mass index was 24 ± 3.1 kg/m 2 . The lesion distance from the anal margin ranged from 5 to 10 cm. The surgical time was 47 min and hospital stay was 2.8 days. One patient was converted to conventional transanal surgery and two patients had self-limited episode of hematochezia. Conclusions: TAMIS is a feasible technique and with promising results in selected patients.

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Transanal endoscopic microsurgery in early rectal cancer: time for a trial?

Abstract: Significant heterogeneity limits conclusions from current literature. A trial is required. Alternate end-points to local recurrence may be required in assessing the optimal surgical approach, which balances disease control with quality of life, and probability of noncancer related death.

Cited by 66 publications

References 59 publications

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Transanal endoscopic microsurgery: impact on fecal incontinence and quality of life

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Cirugía Transanal Por Puerto Único Para La Resección Local De Lesiones De Recto

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