Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas

Graaf, Eelco J. R. de; Burger, Jacobus W. A.; IJsseldijk, A. L. A. van; Tetteroo, G. W. M.; Dawson, I.; Hop, Wim C. J.

doi:10.1111/j.1463-1318.2010.02269.x

Cited by 140 publications

(67 citation statements)

References 23 publications

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“…We were unable to clarify these doubts because we received no reply to our request from the respective study authors. In all, 21 studies met the inclusion criteria for a total of 2,077 patients: 11 ESD series [11][12][13][14][15][16][17][18][19][20][21] totaling 536 patients, and 10 TEM series [2,[22][23][24][25][26][27][28][29][30], totaling 1,541 patients. …”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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“…21 These findings were reproduced in other studies. De Graaf et al 22 compared TAE to TEM for adenomas and had similar findings with regard to fragmentation and resection margins. Interestingly, patients with positive margins in the TEM group had lower recurrence rates than did patients with positive margins in the TAE group (7% vs 59.6%, respectively), concluding that TEM is superior to TAE for rectal adenomas.…”

mentioning

confidence: 61%

“…Interestingly, patients with positive margins in the TEM group had lower recurrence rates than did patients with positive margins in the TAE group (7% vs 59.6%, respectively), concluding that TEM is superior to TAE for rectal adenomas. 22 A recently published systematic review and meta-analysis by Clancy et al 23 compared recurrence rates and pathologic outcomes between TEM and TAE. The authors demonstrated that patients undergoing TEM had a higher rate of negative margins, less specimen fragmentation, and lower lesion recurrence rates with similar complication profiles for both the procedures, but without any significant differences between the groups.…”

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confidence: 99%

Transanal endoscopic surgery: patient selection and perspectives

Petrucci

Sands

2016

OAS

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Abstract:Transanal endoscopic surgery is a 30-year innovation, which has allowed surgeons to treat patients with benign and early malignant rectal tumors using a minimally invasive approach. Its use in colorectal surgery continues to expand and be of interest for surgeons practicing in the minimally invasive surgical era. This review provides an overview of transanal endoscopic surgery, focusing on its different platforms, learning curve, and specific indications for benign and malignant diseases of the rectum. It reviews patient selection, with a focus on patient-and tumor-specific characteristics involved in the selection process, preparation for surgery, complications, and outcomes. Lastly, it reviews novel uses for transanal endoscopic surgery and future prospects.

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“…All patients after TEM are in a postoperative surveillance protocol which includes rigid proctoscopy (plus endorectal ultrasound in a group with invasive cancer) every 3 months during first two years. So far, no recurrent or progressing disease has been found TEM seems to be a satisfactory alternative to trans-anal excision or major abdominal resection for removal of benign rectal lesions However, regardless of a number of articles in the current literature, the superiority of TEM compared to transanal excision was not demonstrated until recently, when de Grafet al [6] demonstrated a statistically significant difference comparing postoperative morbidity between the two procedures (5 3% and 10% respectively). The superiority of either trans anal excision or TEM compared to abdominal resection has been recorded by many authors including Langer et al [7], who however did not show a statistically significant difference in this respect between the two options of trans anal approach.…”

Section: Resultsmentioning

confidence: 97%

Transanal endoscopic microsurgery: A single centre experience

Samalavicius

Kilius

2011

Sri Lanka j Surg

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Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas

Abstract: Transanal endoscopic microsurgery is superior to transanal excision of RA.

Cited by 140 publications

References 23 publications

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Transanal endoscopic surgery: patient selection and perspectives

Transanal endoscopic microsurgery: A single centre experience

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