Impact of transanal endoscopic microsurgery on functional outcome and quality of life

Doornebosch, Pascal G.; Gosselink, M.; Neijenhuis, Peter A.; Schouten, W. R.; Tollenaar, Rob A.E.M.; Graaf, Eelco J. R. de

doi:10.1007/s00384-008-0442-z

Cited by 75 publications

(51 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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...

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Resection of rectum by conventional surgery, in case of unfavourable pathology after TEM, is an option used in our institute successfully. TEM has been shown not to have any long-term effect on anorectal function or quality of life (QOL) [18,19]. The ageing population in the UK is presenting us with management dilemmas for early rectal cancer when conventional surgical resection has been shown to have significantly higher risks of post-operative morbidity and mortality in the elderly [20].…”

Section: Discussionmentioning

confidence: 99%

“…Our patients had a mean age of 71, and a significant proportion (48 %) had an ASA of III or IV. The evidence on selection criteria for TEM is especially poor, and the literature shows that larger tumours (>3 cm) in combination with submucosal invasion depth are significant predictive factors for locoregional failure after TEM for T1 rectal cancer [19,21]. The evidence for oncological safety of TEM for T2 tumours is conflicting.…”

Section: Discussionmentioning

confidence: 99%

Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

et al. 2014

View full text Add to dashboard Cite

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71±10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66±20 mm (range 33-120 mm) with a mean polyp size of 41±24 mm (range 18-110 mm). The mean cancer size was 24±13 mm (range 2-50 mm). Average distance from the anal verge was 70 ±37 mm (range 10-150 mm), and the mean operating time was 72±22 min (range 40-120 min), with an average blood loss of 28±15 ml (range 10-50ml). Median hospital stay was 2±1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13±11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.

show abstract

“…It was demonstrated by endorectal ultrasound that partial lesions of the internal anal sphincter can occur in up to 29% of patients 1 . Other studies have shown no significant changes in incontinence scores or in quality of life questionnaires in the long term evaluation 21,22 . Despite the fact that our patients were not submitted to sphincter evaluation with ultrasound, no anal incontinence was referred in this initial experience.…”

Section: Discussionmentioning

confidence: 99%

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

Filho¹,

Costa²,

Guerra³

2012

J. Coloproctol. (Rio J.)

View full text Add to dashboard Cite

Alves Filho EF, Costa PFO, Guerra JC. Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study. J Coloproctol, 2012;32(4): 402-406. ABSTRACT:Transanal endoscopic microsurgery (TEM) has been used since the 1980's for the treatment of selected rectal cancers, with clear benefits regarding morbidity and mortality, and good oncological outcomes when compared to radical surgery and conventional local resections. The high cost of equipment and the need for long learning curve did not allow the spread of the technique. The aim of this study was to describe the technical characteristics and outcomes of 4 patients operated by this technique, 3 with histologically confirmed adenomas and 1 carcinoid rectal tumor, with no recurrence after an average follow-up of 12 months. The use of single port devices for transanal surgery is a safe method with good oncological results and allows a faster learning curve, by the similarity with conventional laparoscopic procedures and the availability of devices commonly used in laparoscopy. Keywords: colorectal surgery; rectal neoplasms; TAMIS; laparoscopy.ReSumo: A microcirurgia endoscópica transanal (TEM) é usada desde a década de 80 para o tratamento de neoplasias retais selecionadas, com claros benefícios relacionados à mortalidade e morbidade, e com bons resultados oncológicos, em comparação à cirurgia radical e a ressecções locais convencionais. O custo alto de equipamento de TEM e a necessidade de uma curva de aprendizagem longa ainda não permitiram a propagação da técnica. O objetivo deste estudo foi descrever a técnica cirúrgica e os desfechos oncológicos em 4 pacientes operados por esta técnica, 3 com diagnóstico final de adenomas e 1 de tumor carcinoide, sem recorrência após seguimento médio de 12 meses. A utilização de dispositivos de portal único para a cirurgia transanal é um método seguro e com bons resultados oncológicos, permitindo uma curva de aprendizado mais rápida pela semelhança com os procedimentos laparoscó-picos convencionais e pela disponibilidade de dispositivos comumente utilizados em laparoscopia.Palavras-chave: cirurgia colorretal; neoplasias retais; TAMIS; laparoscopia.

show abstract

Impact of transanal endoscopic microsurgery on functional outcome and quality of life

Cited by 75 publications

References 26 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 Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience

Transanal minimally invasive surgery with single-port (TAMIS) for the management of rectal neoplasms: a pilot study

Contact Info

Product

Resources

About