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de Lima RDAL, Parra RS, Feitosa MR, Feres O, da Rocha JJR. Surgical and postoperative evaluations of rectal adenomas excised with a rigid proctoscope. Acta Cir Bras 2020; 35:e202000807. [PMID: 32965304 PMCID: PMC7518222 DOI: 10.1590/s0102-865020200080000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This study presents the surgical and postoperative results achieved with a rigid proctoscope using the transanal endoscopic technique to excise rectal adenomas. The results are compared to the results obtained with other currently employed transanal techniques. METHODS We investigated the medical records of patients who underwent transanal endoscopic operations from April 2000 to June 2018 at two tertiary referral centers for colorectal cancer. RESULTS This study included 99 patients. The mean age was 65.3 ± 13.3 years. The average size of the adenomas was 4.6 ± 2.3 cm, and their average distance to the anal border was 5.6 ± 3.3 cm. The average operative time was 65.3 ± 41.7 min. In 48.5% of the operations, the specimen was fragmented, and in 59.6% of the cases, the microscopic margins were free. The rates of postoperative complications and relapse were 5% and 19%, respectively. The mean follow-up was 80 ± 61.5 months. CONCLUSIONS The described proctoscope proved to be a viable technique with results similar to other techniques, with the advantage that it allowed greater accessibility for surgeons. Therefore, its use could be implemented and become widespread in surgical practice.
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Affiliation(s)
- Roberta Denise Alkmin Lopes de Lima
- Fellow PhD degree, Postgraduate Program in Surgical Clinic, Division of Coloproctology, Department of Anatomy and Surgery, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; manuscript preparation, final approval
| | - Rogério Serafim Parra
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, manuscript writing, critical revision, final approval
| | - Marley Ribeiro Feitosa
- PhD, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, statistics analysis, final approval
| | - Omar Feres
- PhD, Associated Professor, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions, analysis and interpretation of data, critical revision, final approval
| | - José Joaquim Ribeiro da Rocha
- PhD, Associated Professor, Head, Division of Coloproctology, Department of Anatomy and Surgery, FMRP-USP, Ribeirao Preto-SP, Brazil. Substantive scientific and intellectual contributions; conception and design of the study; acquisition, analysis and interpretation of data; critical revision, final approval
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2
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Current Controversies in Transanal Surgery for Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2016; 26:431-438. [DOI: 10.1097/sle.0000000000000357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Transanal use of laparoscopic instrumentation has been described in several case reports as an alternative to transanal endoscopic microsurgery (TEM). Both of these techniques have significant technical limitations due to anatomical constrictions. Robotic technology with articulating instruments has been effectively used in many areas with anatomic limitations similar to the intraluminal use within the rectum. We present the technique of a full-thickness transanal resection of a rectal polyp with endorectal suturing using a robotic platform. Larger case series and trials are needed to compare outcome and cost with TEM. Alternative robotic platforms and instrumentation may be further developed for different and more advanced indications of transanal access surgery.
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Affiliation(s)
- Ovunc Bardakcioglu
- Colon & Rectal Surgery, Saint Louis University, 3635 Vista Avenue, Desloge Towers, 3rd Floor, St. Louis, MO 63110, USA.
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Rocha JJRD, Féres O. Transanal endoscopic operation: a new proposal. Acta Cir Bras 2009; 23 Suppl 1:93-104; discussion 104. [PMID: 18516455 DOI: 10.1590/s0102-86502008000700016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The transanal procedure for rectal cancer surgery is one of the many techniques currently available. Different techniques for local excision of rectal tumors include: conventional transanal technique, posterior access surgery, therapeutic colonoscopy, transanal endoscopic surgery. METHODS The aim of the present study is to describe a new method of transanal endoscopic resection, transanal endoscopic operation (TEO), and performed with the aid of a surgical proctoscope especially designed for this purpose and report the results obtained in 32 patients submitted to the TEO and to compare these results with those obtained with other techniques currently available. The average proportions of recurrence, post-operation complications and posterior resections were analyzed by means of a metanalysis. Data on the distance and size of rectal lesions, the operative timing and hospitalization time were distributed in graphs according to authors and techniques. RESULTS The results were favorable and equivalent to those described in the literature. CONCLUSIONS The surgical proctoscope specially designed for this study is efficient and has a low cost; the TEO is easily performed with the aid of this equipment; the final results were favorable and similar to those obtained with other available techniques for endoscopic transanal intestinal resection, which are of high cost and less availability.
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Affiliation(s)
- José Joaquim Ribeiro da Rocha
- Division of Coloproctology, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine, University of São Paulo, SP, Brazil
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A new proctoscope for transanal endoscopic operations. Tech Coloproctol 2008; 12:241-6. [PMID: 18679568 DOI: 10.1007/s10151-008-0429-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 04/29/2008] [Indexed: 10/21/2022]
Abstract
Transanal access is one of many currently used procedures for rectal cancer treatment. The techniques used for local excision include conventional transanal excision, posterior access, therapeutic colonoscopy and transanal endoscopic approaches. The aim of the present study was to present a new surgical proctoscope for the endoscopic transanal excision of rectal lesions. A cylindrical proctoscope with a diameter of 4 cm was devised and built. The end inserted into the anus has a bevelled aspect and rounded borders, allowing correct exposure of the anal lesion. The rectoscope is fixed to the anal border with surgical thread through perforations in the external end. A base screw holds a fibre-light which illuminates the operative field. Part of the equipment is a guide which is positioned inside the rectoscope on insertion into the anus. In operations utilizing this proctoscope, 17 adenomas, 25 adenocarcinomas, 1 carcinoid and 1 endometrioma were excised. The diameter of the lesions varied from 1 to 6 cm. The range of procedures that are possible with this new proctoscope are similar to those achieved with conventional techniques which, however, require more expensive equipment. Hence, the present study demonstrates that this newly devised low-cost proctoscope is an efficient tool for the transanal endoscopic excision of rectal lesions.
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Whiteford MH, Denk PM, Swanström LL. Feasibility of radical sigmoid colectomy performed as natural orifice translumenal endoscopic surgery (NOTES) using transanal endoscopic microsurgery. Surg Endosc 2007; 21:1870-4. [PMID: 17705068 DOI: 10.1007/s00464-007-9552-x] [Citation(s) in RCA: 241] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 07/19/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES), a recent development in the field of minimally invasive surgery, may offer advantages over open and laparoscopic surgery. Most investigations to date have focused on small end-organ resections, and none have described en bloc regional lymphadenectomy. This study aimed to describe a method of anal transcolonic sigmoid colon resection. METHODS A fresh frozen then thawed cadaver model was used. Three male human cadavers were subjected to transanal sigmoid colon mobilization, high vascular ligation, en bloc lymphadenectomy, and stapled end-to-end anastomosis performed by a single operator using transanal endoscopic microsurgery instrumentation. RESULTS The findings showed that NOTES sigmoid colon resection with en bloc lymphadenectomy and primary anastomosis can be performed successfully. The critical steps of the procedure were (1) luminal suture occlusion of the sigmoid colon, (2) transrectal bowel division, (3) entry through the mesorectum into the presacral space, (4) en bloc mobilization of the sigmoid colon mesentery off of the retroperitoneum, (5) high ligation of the superior hemorrhoidal artery, (6) transanal delivery of the intact sigmoid colon specimen, (7) extracorporeal division of the colon, and (8) creation of a stapled end-to-end colorectal anastomosis. Postprocedure laparotomy confirmed adequate lymphadenectomy and anastomosis with no untoward events. CONCLUSIONS It is possible to complete the critical steps of a NOTES sigmoid resection, en bloc lymphadenectomy, primary anastomosis, and retrieval of an intact specimen without any incisions using transanal endoscopic microsurgery instrumentation.
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Affiliation(s)
- M H Whiteford
- Gastrointestinal and Minimally Invasive Surgery Division, Legacy Portland Hospitals, 1040 NW 22nd Avenue, Suite 560, Portland, OR, 97232, USA.
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Kinoshita T, Kanehira E, Omura K, Tomori T, Yamada H. Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg Endosc 2007; 21:970-4. [PMID: 17285371 DOI: 10.1007/s00464-006-9155-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2006] [Revised: 08/12/2006] [Accepted: 11/30/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to assess the efficacy of transanal endoscopic microsurgery (TEM) in the treatment of rectal carcinoid tumor. METHODS Between May 1994 and April 2006, 27 patients with rectal carcinoid tumor underwent TEM, and their clinical data were reviewed retrospectively. RESULTS The TEM procedure was performed as a primary excision (n = 14) or as completion surgery after incomplete resection by endoscopic polypectomy (n = 13). The average size of a primary tumor was 9.1 mm (range, 5-13 mm), and the average distance of the tumor from the anal verge was 8.5 cm. The mean duration of the operation was 51.6 min. Minor morbidities, transient soilage, and mild dehiscence occurred in two cases (7.4%). Histopathologically, all tumors were localized within the submucosal layer showing typical histology without lymphatic or vessel infiltration, and both deep and lateral surgical margins were completely free of tumors. Among 13 cases of completion surgery after endoscopic polypectomy, 4 (30.8%) were histologically shown to have a residual tumor in the specimens obtained by TEM. No additional radical surgery was performed. The mean follow-up period was 70.6 months, and no recurrence was noted. CONCLUSION The results indicate that TEM is a safe, minimally invasive procedure for the local excision of rectal carcinoid tumors, particularly those in the proximal rectum. Furthermore, for patients with microscopic positive margins after endoscopic polypectomy, TEM can be an effective surgical option for complete removal of residual tumors.
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Affiliation(s)
- T Kinoshita
- Endoscopic Surgery Center, Toho University Sakura Medical Center, Shimoshizu, Sakura, Chiba, Japan.
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Nano M, Ferronato M, Solej M, D'Amico S. T1 Adenocarcinoma of the Rectum: Transanal Excision or Radical Surgery? TUMORI JOURNAL 2006; 92:469-473. [DOI: 10.1177/030089160609200601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Mario Nano
- Department of Clinical Pathophysiology, Third Division of General Surgery, University of Turin, Turin, Italy
| | - Marco Ferronato
- Department of Clinical Pathophysiology, Third Division of General Surgery, University of Turin, Turin, Italy
| | - Mario Solej
- Department of Clinical Pathophysiology, Third Division of General Surgery, University of Turin, Turin, Italy
| | - Silvia D'Amico
- Department of Clinical Pathophysiology, Third Division of General Surgery, University of Turin, Turin, Italy
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Schäfer H, Baldus SE, Hölscher AH. Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 2006; 21:533-7. [PMID: 16133003 DOI: 10.1007/s00384-005-0025-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND Large sessile adenomas of the rectum, with a diameter greater than 5 cm, have a high risk to undergo malignant transformation. Transanal endoscopic microsurgery (TEM) offers an alternative operation method to low-anterior rectum resection in this potentially benign tumor situation. PATIENTS We retrospectively investigated patients with giant adenomas of the rectum (>5 cm) who were treated by TEM over the last 10 years. A total of 33 patients met the criteria and were analyzed for postoperative complications, histology, and incidence of occult adenocarcinoma; residual tumor status; and tumor recurrence. RESULTS Partial suture-line insufficiency (n=5, 15%) was the major postoperative complication, but could be managed conservatively in four cases. The residual adenoma status was 18% (n=6), especially in patients with tumors sizes more than 30 cm2. In case of adenoma recurrence (n=4, 12%), a conventional transanal excision (Parks) was applicable, as these tumors were mostly located within the suture-line region of the lower rectum. Incidentally, five carcinomas were found in the specimens. In case of advanced tumors (1xpT2, 1xpT3), anterior rectum resection was carried out, whereas for the early tumors (2xpT1 low risk, 1x1 pTis), no further therapy was added. All patients (adenomas and carcinomas, n=33) were without recurrence during follow-up. CONCLUSION TEM is an alternative method for the resection of large benign rectal tumors located in the mid- and upper third of the rectum. The main postoperative complication is suture-line insufficiency, which generally heals by conservative treatment.
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Affiliation(s)
- Hartmut Schäfer
- Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Str. 9, 50924 Cologne, Germany.
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Guillem JG, Chessin DB, Jeong SY, Kim W, Fogarty JM. Contemporary Applications of Transanal Endoscopic Microsurgery: Technical Innovations and Limitations. Clin Colorectal Cancer 2005; 5:268-73. [PMID: 16356304 DOI: 10.3816/ccc.2005.n.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure used to transanally excise select benign and malignant tumors of the rectum. In properly selected patients, TEM can provide for decreased postoperative morbidity without compromising oncologic outcome. This report summarizes the recent literature concerning TEM, comprehensively analyzes the authors' experience with TEM, and describes recent technical innovations and indications. PATIENTS AND METHODS Thirty-two consecutive patients scheduled for TEM were identified from our prospectively maintained colorectal service database. Clinicopathologic factors, postoperative complications, and oncologic outcomes were analyzed for all patients. In addition, a PubMed literature search was performed with use of the key words "transanal endoscopic microsurgery," "TEM," "rectal tumor," and "rectal cancer." RESULTS Transanal endoscopic microsurgery was performed for rectal adenocarcinoma (n = 17; 53%), adenoma (n = 12; 38%), and carcinoid tumors (n = 3; 9%). Median tumor location was 9 cm from the anal verge (range, 3-15 cm). Of the 32 attempted TEM procedures, 27 (84%) were completed. Reasons for inability to complete TEM included narrow rectal lumen or contour of bony pelvis prohibiting passage of the operating proctoscope into the upper rectum and inability to maintain the proctoscope in the rectal lumen with carbon dioxide insufflation because of the distal location of the tumor. Innovations used in the excision of rectal tumors via TEM included the use of the harmonic scalpel, closure of the rectal defect with an extracorporeal slip knot, and a hybrid approach incorporating TEM and traditional transanal techniques. CONCLUSION Transanal endoscopic microsurgery provides for low morbidity and does not appear to impair oncologic outcome in properly selected patients.
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Affiliation(s)
- Jose G Guillem
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Rm. C-1077, New York, NY 10021, USA.
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11
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Ishikawa K, Arita T, Shimoda K, Hagino Y, Shiraishi N, Kitano S. Usefulness of transanal endoscopic surgery for carcinoid tumor in the upper and middle rectum. Surg Endosc 2005; 19:1151-4. [PMID: 16021383 DOI: 10.1007/s00464-004-2076-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 02/11/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study evaluated the indications and outcome for transanal endoscopic surgery (TES) used to manage rectal carcinoid tumor as compared with those of conventional transanal local resection (TAR). METHODS The retrospective study subjects were 28 patients with rectal carcinoid tumor treated by TES (n = 17) or TAR (n = 11) between January 1995 and December 2001. Patient and tumor characteristics, operative results, and postoperative outcomes were compared between the two groups. RESULTS The distance from the anal verge to the distal tumor margin in the TES group (range, 4-12 cm; median, 6.8 cm) was significantly greater than in the TAR group (range, 3-6 cm; median, 4.5 cm) (p = 0.001). The median tumor diameter was 5.5 mm (range, 3-11 mm) in the TES group and 5.0 mm (range, 3-8 mm) in the TAR group, showing no statistical difference. Microscopically, resected specimens in both groups were typical carcinoid tumors restricted to the submucosal layer. No recurrence was noted in either group. CONCLUSION Whereas TES is useful for patients with small rectal carcinoid tumor of typical histology within the submucosal layer in the upper and middle rectum, TAR is effective for accessing the lower rectum.
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Affiliation(s)
- K Ishikawa
- Surgery Division, Arita Gastrointestinal Hospital, 1-2-6 Maki, Oita, 870-0924, Japan.
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Decker CJ. Transanal excision of rectal villous adenomas by laparoscopic methods. J Laparoendosc Adv Surg Tech A 2005; 15:23-7. [PMID: 15772472 DOI: 10.1089/lap.2005.15.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Large villous adenomas of the rectum are not uncommon and will be encountered often by general and colorectal surgeons in their practices. The approach to large adenomas can be via the colonoscope either transabdominally or transanally. A simple transanal method was instituted by the author in 1992 and has been used up to the time of writing. This involves using a 4-cm diameter transanal operating rectoscope with laparoscopic instruments and the laparoscope itself. The results for 13 patients from January 1992 to April 2001 are reviewed. The method is simple and allows access to lesions up to 15 cm from the anal verge with a low incidence of complications, residual disease, and recurrence.
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Abstract
Local excision of rectal cancer is advocated for cure only in selected patients. It should be done according to specific standards and needs close follow up. The transanal technique is well defined and indicated for posterior rectal wall tumours. Otherwise, technical modifications or microsurgery can be performed. The transacral approach should be abandoned.
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Affiliation(s)
- C Gouillat
- Département de chirurgie, hôpital de l'Hôtel-Dieu, 1, place de l'Hôpital, 69288 Lyon cedex 2, France
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Abstract
PURPOSE The aim of this study was to systematically review the evidence relating to the safety and efficacy of transanal endoscopic microsurgery, a relatively new technique used to locally excise rectal tumors, compared with existing techniques such as anterior resections and abdominoperineal resections or local excisions. METHODS We conducted a systematic review of comparative studies and case series of transanal endoscopic microsurgery from 1980 to August 2002. RESULTS Three comparative studies (including one randomized, controlled trial) and 55 case series were included. The first area of study was the safety and efficacy of adenomas. In the randomized, controlled trial, no difference could be detected in the rate of early complications between transanal endoscopic microsurgery (10.3 percent) and direct local excision (17 percent) (relative risk, 0.61; 95 percent confidence interval, 0.29-1.29). Transanal endoscopic microsurgery resulted in less local recurrence (6/98; 6 percent) than direct local excision (20/90; 22 percent) (relative risk, 0.28; 95 percent confidence interval, 0.12-0.66). The 6 percent rate of local recurrence for transanal endoscopic microsurgery in this trial is consistent with the rates found in case series of transanal endoscopic microsurgery (median, 5 percent). The second area of study was the safety and efficacy of carcinomas. In the randomized, controlled trial, no difference could be detected in the rate of complications between transanal endoscopic microsurgery and direct local excision (relative risk for overall early complication rates, 0.56; 95 percent confidence interval, 0.22-1.42). No differences in survival or local recurrence rate between transanal endoscopic microsurgery and anterior resection could be detected in either the randomized, controlled trial (hazard ratio,1.02 for survival) or the nonrandomized, comparative study. There were 2 of 25 (8 percent) transanal endoscopic microsurgery recurrences in the randomized, controlled trial, but no figures were given for recurrence after anterior resection. In the case series, the median local recurrence rate for transanal endoscopic microsurgery was 8.4 percent, ranging from 0 percent to 50 percent. The third comparison was cost of the procedures. Transanal endoscopic microsurgery had both a lower recurrence rate and a lower cost than local excision or anterior resection for adenomas. Although the effectiveness of transanal endoscopic microsurgery could not be established for carcinomas, costs were lower than those for either anterior resection or abdominoperineal resection. CONCLUSIONS The evidence regarding transanal endoscopic microsurgery is very limited, being largely based on a single relatively small randomized, controlled trial. However, transanal endoscopic microsurgery does appear to result in fewer recurrences than those with direct local excision in adenomas and thus may be a useful procedure for several small niches of patient types--e.g., for large benign lesions of the middle to upper third of the rectum, for T1 low-risk rectal cancers, and for palliative, not curative, use in more advanced tumors.
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Abstract
OBJECTIVE Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of rectal adenomas and also in selected cases of rectal carcinomas. The aim of this study was to assess the results in a consecutive series of patients after introducing the TEM technique. PATIENTS AND METHODS All 58 patients operated with TEM from January 1996 to January 1999 were evaluated in a retrospective review. Forty-eight patients answered a clinically validated questionnaire a median of 22 months after TEM. Eighty patients who had undergone transanal excision and 12 who had undergone York Mason's procedure served as a reference group with respect to recurrence rates. RESULTS The complication rate was 5% (immediate) and 14% (long-term). The overall 30-day mortality rate was zero. An impairment of continence was seen in 18 (37%) patients. Of these, all 18 experienced varying degree of incontinence to liquid stool, 14 also to flatus and 5 of them even to solid stool. The recurrence rate was 11% in adenomas and 14% in cancers; T1, 1 (10%) recurrence and T2, 1 (50%) recurrence. There was a correlation between operating time and impairment of continence as well as recurrence rate. CONCLUSION TEM is a safe procedure, having a low recurrence rate and an acceptable functional outcome.
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Affiliation(s)
- G Dafnis
- Department of Surgery, University Hospital, Uppsala, Sweden.
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Abstract
OBJECTIVE Transanal endoscopic microsurgery (TEM), a minimally invasive technique has been employed in the excision of benign and well-selected malignant rectal tumours since June 1998. We present a prospective descriptive study and analyse the currently accepted indications. PATIENTS AND METHODS Over a 4-year period 100 patients underwent TEM for treatment of rectal tumours located between 4 and 18 cm from the anal verge. RESULTS TEM was performed in 71 cases for adenomas, 20 potentially curative excisions for pre-operative staged low-grade carcinoma, 3 palliative procedures for advance carcinoma, 5 carcinoids and 1 solitary ulcer. The local complication rate included wound breakdown in 7 patients, three of them requiring ileostomy. Conversion to laparotomy was performed in two patients. Five adenomas recurred and were successfully treated by TEM. Of the cancers, four patients required immediate salvage therapy by means of total mesorectal excision. Three patients underwent palliative TEM procedures combined with radiotherapy. A single cancer recurrence was treated by means of abdomino-perineal resection after radiotherapy. CONCLUSIONS TEM appears to be an effective method of excising benign tumours and selected T1 carcinomas of the rectum. The superior exposure of tumours higher in the rectum combined with the greater precision of excision make this minimally invasive technique an attractive surgical approach.
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Affiliation(s)
- P Palma
- Department of Surgery, University Clinic, Mannheim, Germany.
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Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 2004; 187:630-4. [PMID: 15135680 DOI: 10.1016/j.amjsurg.2004.01.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2003] [Revised: 01/19/2004] [Indexed: 02/07/2023]
Abstract
PURPOSE Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for full-thickness excision of benign and malignant rectal neoplasms located 4 to 24 cm above the anal verge. Entrance into the peritoneal cavity during TEM has been regarded as a complication that mandates conversion to open laparotomy for adequate repair of the defect. This study compares the rate of complications arising from TEM with and without intraperitoneal entry. METHODS Patients undergoing peritoneal entry were compared to those who did not. RESULTS No perioperative deaths occurred. There was no significant difference in the incidence of postoperative complications. No major complications occurred with peritoneal entry, and all peritoneal entries were closed transanally via endoscope. CONCLUSIONS Entry into the peritoneum during TEM is not associated with an increased incidence of complication. Entry into the peritoneum during TEM excision does not mandate conversion to open laparotomy but may be safely repaired endoscopically. Lesions likely to be above the peritoneal reflection and within reach of the endoscope (4 to 24 cm) should be considered for TEM excision.
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Affiliation(s)
- Justine A Gavagan
- Department of Minimally Invasive Surgery, Legacy Health System, 1040 NW 22nd Ave., Suite 560, Portland, OR 97210, USA
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Nakagoe T, Tanaka K, Yasutake T, Sawai T, Tsuji T, Nanashima A, Shibasaki SI, Yamaguchi H, Ayabe H. Long-term outcomes of intragastric endoscopic mucosal resection using a modified buess technique for early gastric cancer. Dig Surg 2003; 20:141-7. [PMID: 12686783 DOI: 10.1159/000069391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2002] [Accepted: 08/12/2002] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to clarify long-term outcomes of endoscopic mucosal resection (EMR) using a modified Buess technique for mucosal gastric cancer. METHODS The procedure included en bloc mucosal resection using a Buess-type rectoscope into the gastric lumen via a temporary gastrostomy under video camera guidance. We reviewed 5 patients who underwent this procedure between 1995 and 1997 with a single mucosal cancer of the stomach that was unsuitable for en bloc excision by endoscopic snare diathermy. RESULTS All tumors were superficial elevated types (type 0-IIa) located in the middle third and posterior wall of the stomach. Median maximum tumor diameter was 2.2 (range 1.1-3.5) cm. There was no operative mortality. One patient developed a hemorrhagic gastric ulcer postoperatively. All tumors histologically showed curative potential of the mucosal resection without margin involvement. During a median follow-up period of 64 (50-77) months, none of the patients developed local recurrence. One patient had an early gastric cancer that metachronously developed at another stomach site. CONCLUSION Intragastric EMR using a modified Buess technique appears to be a useful treatment for cure of mucosal gastric cancer for a limited group of patients unsuitable for complete en bloc excision by endoscopic snare diathermy.
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Affiliation(s)
- T Nakagoe
- First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Jibiki M, Nanashima A, Yamaguchi H, Yasutake T. Gasless, video endoscopic transanal excision for carcinoid and laterally spreading tumors of the rectum. Surg Endosc 2003; 17:1298-304. [PMID: 12739126 DOI: 10.1007/s00464-002-8580-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Accepted: 12/07/2002] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study is to determine whether gasless, video endoscopic transanal-rectal tumor excision (gasless VTEM) is a valid treatment for rectal carcinoid and laterally spreading tumors (LST). METHODS Eighty-four patients with an adenoma, adenocarcinoma (Tis/T1), or carcinoid tumor of the rectum were divided into three groups: (i) LST ( n = 17 patients), (ii) carcinoid ( n = 11), and (iii) control with other types of tumors ( n = 56). RESULTS The LST group had a longer median operating time than in the control group, whereas the carcinoid group had a shorter operating time. Two patients (11.7%) in LST group developed peritoneal entry during the operation, while 2 patients (3.6%) in the control group experienced postoperative complications. During a median follow-up length of 55.2 months, one patient in the LST group developed a recurrence. CONCLUSIONS Gasless VTEM is a simple, minimally invasive procedure used to treat LST and carcinoid tumors of the rectum. However, resection for the LST group had a high risk of peritoneal entry during operation.
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Affiliation(s)
- T Nakagoe
- First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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20
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Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Shibasaki SI, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H. Gasless video endoscopic transanal excision of rectal tumors incompletely removed by colonoscopic snare polypectomy. J Laparoendosc Adv Surg Tech A 2003; 13:99-103. [PMID: 12737723 DOI: 10.1089/109264203764654722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This report describes an experience with gasless video transanal endoscopic microsurgery (VTEM) to excise rectal tumors previously incompletely removed with colonoscopic snare polypectomy. METHODS Gasless VTEM involves a modification of transanal endoscopic microsurgery (TEM) that incorporates a standard laparoscopic video camera and requires no CO(2) insufflation system. Nineteen patients who had had a rectal tumor removed incompletely by colonoscopic polypectomy with a diathermy snare were enrolled in this prospective study. The patients included 14 men and 5 women whose median age was 63.5 (range, 49-83) years. The rectal tumors included 4 adenomas, 11 adenocarcinomas (Tis, 7; T1, 4), and 4 carcinoid tumors. The median distance from the tumor margin to the dentate line was 5.8 (range, 2.0-13.0) cm. RESULTS All rectal lesions were successfully removed by gasless VTEM. No intraoperative complication occurred. The median operating time and blood loss were 40 (range, 15-145) minutes and 5 (range, 0-100) mL, respectively. The median maximal tumor diameter in 9 patients with residual tumors was 1.3 (range, 0.5-2.5) cm. There was no operative mortality. A postoperative complication (bleeding from a suture wound and transient incontinence) developed in 1 (5.3%) of the 19 patients. The median postoperative hospital stay was 5 (range, 2-10) days. Postoperative histology revealed a residual tumor in 10 (52.9%) of the 19 specimens. Complete excision of all tumors was confirmed histologically. During a median follow-up period of 59.5 (range, 12.3-94.9) months, no tumor recurred. CONCLUSIONS Gasless VTEM is useful and minimally invasive for the local removal of rectal tumors incompletely resected by colonoscopic snare polypectomy.
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Affiliation(s)
- Tohru Nakagoe
- First Department of Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
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21
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Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Tanaka K, Ayabe H. Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision. Br J Surg 2002; 89:769-74. [PMID: 12027989 DOI: 10.1046/j.1365-2168.2002.02097.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) is unpopular because of its high cost and most surgeons' unfamiliarity with microscopic surgery. This report describes an experience with a modification of TEM, gasless video endoscopic transanal rectal tumour excision (gasless VTEM), which incorporates a standard laparoscopic video camera and requires no carbon dioxide insufflation system. METHODS One hundred and one patients with 105 rectal tumours underwent gasless VTEM between 1993 and 2000. RESULTS Histological examination revealed 18 adenomas, 75 carcinomas (Tis, 47; T1, 23; T2, five), 11 carcinoid tumours and one lymphoma. The median height above the dentate line and maximum tumour diameter was 5.0 (range 2-14) cm and 2.0 (range 0.4-8.0) cm respectively. The peritoneal cavity was opened intraoperatively in two patients. The median operating time was 53 (range 15-202) min. Bleeding, suture dehiscence and transient incontinence developed after operation in four patients. There was no operative death. Median hospital stay was 5 (range 1-21) days. Eleven patients with T1/T2 staging underwent subsequent radical resection. The median duration of follow-up was 52.3 months. One patient with a carcinoma developed a recurrence. CONCLUSION Gasless VTEM is a feasible, safe and minimally invasive procedure for the treatment of selected rectal adenomas and early carcinomas. The suggested modifications may make the procedure more widely available.
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Affiliation(s)
- T Nakagoe
- First Department of Surgery, Nagasaki University School of Medicine and Department of Surgery, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Sutton CD, Marshall LJ, White SA, Flint N, Berry DP, Kelly MJ. Ten-year experience of endoscopic transanal resection. Ann Surg 2002; 235:355-62. [PMID: 11882757 PMCID: PMC1422441 DOI: 10.1097/00000658-200203000-00007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To audit the results of endoscopic transanal resection of tumor (ETAR) performed by a single surgeon at a specialized colorectal unit during a 10- year period. SUMMARY BACKGROUND DATA A minimally invasive surgical technique, ETAR has enabled much progress to be made in the development of local treatment strategies for rectal neoplasia. It can be used in both the curative and palliative management of rectal lesions and is a treatment option for patients who would be unable to tolerate major surgery. METHODS The surgical outcome of 104 patients (43 women, 61 men) undergoing ETAR under the care of a single surgeon between 1989 and 1999 was reviewed. Patients were identified from the consultant's personal records and cross-referenced with operating room logs. Data were collected retrospectively and no patients were lost to follow-up. RESULTS One hundred four patients underwent 163 procedures during the study period. Follow-up ranged from 6 months to 10 years. Seventy-five patients with a pre-ETAR diagnosis of benign rectal adenoma underwent resection. In 60 patients, the diagnosis was confirmed to be benign; 30 of these were treated with a single resection and 28 with multiple resections. There were two technical failures, both a result of high mobility of the lesion. In no patients did carcinoma subsequently develop. In the remaining 15 patients the final histology demonstrated a malignancy; 9 patients underwent an open surgical rectal resection and 5 had complete endoscopic resection of their lesion. No carcinomas that were fully resected endoscopically have recurred (follow-up 13 months to 8years). The final patient had an extensive rectal cancer and was palliated for 2 months by ETAR. Twelve patients (8 men, 4 women) underwent ETAR for anastomotic strictures; successful treatment was achieved in 11. The one failure was in a Park's pouch that was subsequently refashioned. Seventeen patients underwent 30 ETARs for palliation of nonresectable rectal adenocarcinoma. Successful palliation of symptoms was achieved in 13 patients and the remainder underwent colostomy formation. One patient died of a myocardial infarction. There were two further complications (blood transfusion for postoperative bleeding, postoperative cerebrovascular accident). CONCLUSIONS Endoscopic transanal resection of tumor is safe and effective and offers successful palliation or definitive treatment of rectal lesions with low rates of death and complications when performed by a dedicated surgeon.
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Affiliation(s)
- Christopher D Sutton
- Department of Surgery, Leicester General Hospital, University Hospitals of Leicester, Leicester, England.
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Abstract
PURPOSE Although local excision of rectal cancers is a less morbid alternative to radical resection, its role as a curative procedure is unclear. The role of adjuvant therapy after local excision is also controversial. This review aims to examine current evidence on local excision of rectal cancers and how it fits into the management algorithm for rectal cancer. METHODS A literature review was undertaken through the MEDLINE database and by cross-referencing previous publications, thus identifying 41 studies on curative local excision of rectal cancer published in English. Details of preoperative staging, surgical procedures, adjuvant therapy, follow-up, and outcome measures, including complications, survival data, recurrences, and salvage were examined. RESULTS Preoperative staging of rectal cancers is variable. Digital rectal examination and computerized tomography are used in most studies. Endorectal ultrasound is used in some patients in 9 of 41 studies. Local excision preserves anorectal function, and seems to have limited morbidity (0-22 percent). Local excision alone is associated with local recurrences in 9.7 (range, 0-24) percent of T1, 25 (range, 0-67) percent of T2 and 38 (range, 0-100) percent of T3 cancers. The addition of adjuvant chemoradiotherapy after local excision yields local recurrence rates of 9.5 (range, 0-50) percent for T1, 13.6 (range, 0-24) percent for T2, and 13.8 (range, 0-50) percent for T3 cancers. Data on local excision after preoperative chemoradiotherapy for tumor down staging are limited. Factors other than T-stage that lead to higher local recurrence rates after local excision include poor histologic grade, the presence of lymphovascular invasion, and positive margins. Local recurrences after local excision can be surgically salvaged (84 of 114 patients in 15 studies), with a disease-free survival rates between 40 and 100 percent at a follow-up of 0.1 to 13.5 years. CONCLUSIONS Local excision for rectal cancers is associated with a low morbidity and provides satisfactory local control and disease-free survival rates for T1 rectal cancers. There is, however, a need for a randomized, controlled trial for T2 cancers, comparing local excision with adjuvant chemoradiotherapy to radical resection.
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Affiliation(s)
- S Sengupta
- Department of Surgery, Colorectal Unit, Royal Melbourne Hospital, University of Melbourne, Australia
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Demartines N, von Flüe MO, Harder FH. Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 2001; 25:870-5. [PMID: 11572026 DOI: 10.1007/s00268-001-0043-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Transanal endoscopic microsurgery (TEM) allows local excision of rectal tumors located 4 to 18 cm above the anal verge. The technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical aspects of the approach, and the stringent patient selection criteria. The aim of this prospective, descriptive study was to analyze the currently accepted indications for TEM and to evaluate the use of this procedure for treating rectal cancer. Over a 4-year period 50 patients aged 31 to 86 years (mean 64 years) underwent TEM for treatment of rectal tumors located 12 cm above the anal verge (range 4-18 cm). The local complication rate was 4%. Altogether, 76% of lesions were benign, and 24% were T1 and T2 tumors. Of 12 cancer cases, 4 required reoperation by total mesorectal resection; the other 8 are currently under follow-up management. Over the follow-up period of 30.6 months (range 11-54 months) the recurrence rate of T1 tumors was 8.3%. TEM is a minimally invasive surgical technique that may benefit a small, specific population of patients with rectal tumors. Compared with conventional transanal resection, TEM provides superior exposure of tumors higher up in the rectum (i.e., up to 18 cm from the anal verge). The greater precision of resection combined with low morbidity (10%, relative to that of anterior resection) and short duration of hospitalization (5.5 days) make this technique a reliable and in some cases more effective surgical approach than laparotomy and low anterior resection.
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Affiliation(s)
- N Demartines
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland.
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Langer C, Markus P, Liersch T, Füzesi L, Becker H. UltraCision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Advantages of a new procedure. Surg Endosc 2001; 15:513-7. [PMID: 11353972 DOI: 10.1007/s004640090015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2000] [Accepted: 09/28/2000] [Indexed: 12/19/2022]
Abstract
The potential advantages of ultrasound dissection using UltraCision (UC) an ultrasonically activated scalpel, rather than conventional electrosurgery (ES) were investigated retrospectively in 63 patients following transanal endoscopic microsurgery (TEM) in 22 cases of rectal carcinoma (16 pT1, four pT2, two pT3), 40 cases of rectal adenoma >2 cm, and one neurinoma. In all, 21 patients (13 adenomas, seven carcinomas, and one neurinoma) were operated with UltraCision (Ethicon, Norderstedt, Germany), whereas 42 patients (27 adenomas, 15 carcinomas) were treated with conventional electrocautery. All tumors were completely excised (R0) in both groups. We encountered a total of nine complications, seven after ES and two after UC use. Surgical reintervention was necessary in three cases (4.7%), exclusively following resection by ES. There were five cases of tumor recurrence (7.9%), once again only in the ES group. The advantages of ultrasound dissection are magnified under the particular conditions of minimally invasive endoscopic rectum surgery by means of TEM. In principle, all the known risks associated with the application of electric current can be avoided by using ultrasound technology.
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Affiliation(s)
- C Langer
- Department of General Surgery, Georg August University Göttingen, Robert Koch Strasse 40, 37075 Göttingen, Germany.
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Transanal Endoscopic Microsurgery for Excision of Rectal Lesions: Technique and Initial Results. Surg Laparosc Endosc Percutan Tech 2000. [DOI: 10.1097/00129689-200012000-00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Azimuddin K, Riether R, Stasik J, Rosen L, Khubchandani I, Reed J. Surg Laparosc Endosc Percutan Tech 2000; 10:372-378. [DOI: 10.1097/00019509-200012000-00007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reed DN, Vitale GC. Interventional endoscopic retrograde cholangiopancreatography and endoscopic surgery. Surg Clin North Am 2000; 80:1171-201. [PMID: 10987030 DOI: 10.1016/s0039-6109(05)70219-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Interventional endoscopic techniques have been indespensible in almost every area of modern surgery. As surgeons, we need to continue to advance our skills in these areas if we expect to continue to be involved in these aspects of patient care.
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Affiliation(s)
- D N Reed
- Department of Surgery, University of Louisville School of Medicine, Kentucky, USA
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Ikeda, Mori, Abe, Koyanagi, Akahoshi, Sugimachi. Indications for performing transanal endoscopic microsurgery (TEM) in rectal cancer patients. Colorectal Dis 2000; 2:13-7. [PMID: 23577928 DOI: 10.1046/j.1463-1318.2000.00131.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this study was to clarify the application of a local excision using TEM for rectal cancer. PATIENTS AND METHODS Fifteen patients were preoperatively diagnosed to have cancer invasion in the submucosa (T1) and thus were treated by TEM, while 13 others were preoperatively diagnosed to have cancer invasion reaching the muscularis propria (T2) and thus were treated by a radical operation. Surgical specimens from all 28 patients were pathologically examined and compared with the preoperative evaluation. RESULTS The mean operating time for TEM was 53 min. The accuracy of the preoperative evaluation for the depth of cancer invasion was 68% (19/28). In the 15 patients with preoperative evaluation of T1 cancer, two pathologically showed cancer invasion into muscularis propria. In the 13 patients with a preoperative evaluation of T2 cancer, three pathologically showed cancer invasion within the submucosa. CONCLUSION Since some patients with a preoperative evaluation of T2 rectal cancer showed the possibility of a complete cure with a local excision, preoperative T2 stage rectal cancer is considered to be a good candidate for a local excision using TEM.
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Affiliation(s)
- Ikeda
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan, Department of Surgery, Iizuka Hospital, Fukuoka, Japan, Department of Surgery, Medical Institute of Bioregulation, Kyushu University, Beppu, Fukuoka, Japan, Department of Gastroenterology, Iizuka Hospital, Fukuoka, Japan
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31
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Slisow W, Moesta KT, Schlag PM. Local excision of rectal cancer through windowed specula: long-term results. Recent Results Cancer Res 1998; 146:114-123. [PMID: 9670255 DOI: 10.1007/978-3-642-71967-7_11] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Transanal local excision of rectal cancer has been advocated as a curative option in patients with early rectal cancer and for patients unsuitable for radical surgery. We report our long-term experience with an easy-to-use and inexpensive technique based on windowed specula. From 1982 to 1994, 137 patients with rectal cancer were treated by local excision with curative intention. An R0 resection was possible in 74% of all patients and in 80% of the patients with a tumor surface of less than 9 cm2. Ninety patients with a follow-up of more than 3 years (T1: n = 50, T2: n = 30, T3: n = 14) were evaluated for survival. Seventy-four of these 90 patients are currently alive. The cause of death is known for all 16 deceased patients. In 4, death was tumor-related; 3 of these patients had a component of local failure. In 6 of 8 patients with local recurrence, a radical reresection was possible. The rate of recurrence increased with T category and with tumor grade. There has been one recurrence in a patient with a T1G1 cancer. The instrumentation enables adequate local excision of rectal cancers of less than 9 cm2 surface area. In this group of patients including a considerable number with T2 and T3 cancers, only 3 died of tumor-related causes with a component of local failure, which compares well with mortality rates above 4% for abdominoperineal excision. Comparison with international data on radical surgery shows that the overall survival is not reduced by local transanal excision for early rectal cancer.
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Affiliation(s)
- W Slisow
- Department of Surgery and Surgical Oncology, Robert Rössle Hospital, Charité Humboldt University of Berlin, Germany
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