Minimally invasive transanal surgery is safe after incomplete polypectomy of low risk T1 rectal cancer: a systematic review

Jong, Gabie M. de; Hugen, Niek

doi:10.1111/codi.14659

Cited by 10 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings suggest that, in selected patients, long-term oncological outcomes after endoscopic excision of the polyp by EMR or ESD are no different to current clinical practice in a centre where all three options are available at expert level and describes the dilemmas encountered at MDT. Several previous studies have examined oncological outcomes after local excision and radical surgery [3,[11][12][13]15]. However, most of these studies have included both colonic and rectal cancer making it difficult to draw conclusions about rectal cancer specifically [13].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, with the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), it is now possible to resect more advanced polyps and early cancers safely [7][8][9][10]. Both techniques are increasingly used for early rectal cancer and a number of studies have demonstrated that it is also safe to perform a TEM/ TAMIS after a polyp resection [11][12][13][14][15].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Oncological outcome after local treatment for early stage rectal cancer

et al. 2021

View full text Add to dashboard Cite

Background Treatment of early rectal cancer is evolving towards organ-preserving therapy which includes endoscopic resection and transanal approaches. We aimed to explore the role of local treatments such as endoscopic polypectomy (Endoscopic Mucosal Resection (EMR) or Endoscopic submucosal dissection (ESD)) and transanal endoscopic microsurgery/ transanal minimal invasive surgery (TEM/TAMIS) in patients who had early rectal cancer. We considered these outcomes alongside conventional major surgery using total mesorectal excision (TME) for early stage disease. Methods All patients identified at MDT with early stage rectal cancer at our institution between 2010 and 2019 were included. Long-term outcomes in terms of local recurrence, survival and procedure-specific morbidity were analysed. Results In total, 536 patients with rectal cancer were identified, of which 112 were included based on their pre-operative identification at the MDT on the basis that they had node-negative early rectal cancer. Among these, 30 patients (27%) had the lesion excised by flexible endoscopic polypectomy techniques (EMR/ESD), 67 (60%) underwent TEM/TAMIS and 15 (13%) had major surgery. There were no differences in patient demographics between the three groups except for TEM/TAMIS patients being more likely to be referred from another hospital (p < 0.001) and they were less active (WHO performance status p = 0.04). There were no significant differences in overall survival rates and cancer-specific survival between the three treatment groups. The 5-year overall survival rate for endoscopic polypectomy, TEM/TAMIS or major resection was 96% versus 90% and 88%, respectively (p = 0.89). The 5- year cancer-specific survival rate was 96%, versus 96% and 100%, respectively (p = 0.74). Conclusion Endoscopic polypectomy by EMR/ESD is an appropriate local treatment for early stage rectal cancer in selected patients. It is possible to achieve good oncological outcomes with a polypectomy similar to TEM/TAMIS and major surgery; however, a multidisciplinary approach is necessary enabling close surveillance and the use of adjuvant radiotherapy.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Oncological outcome after local treatment for early stage rectal cancer

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Because rectal cancer patients have no specific clinical symptoms in the early stage, with the progression of disease, patients will suffer from different degrees of constipation and diarrhea. Nowadays, rectal cancer diseases are mostly detected by proctoscope and digital rectal examination, and rectal cancer masses are characterized by rapid growth, uneven surface, and hard texture [12][13][14]. Surgical resection is currently one of the most commonly used methods in the clinical treatment of rectal cancer, but because most patients are diagnosed in the middle and late stage, the clinical efficacy of surgical resection is not ideal, with high postoperative recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Radiotherapy Combined with Capecitabine after Neoadjuvant Therapy for Rectal Cancer

Zhang

Teng

2021

Journal of Oncology

View full text Add to dashboard Cite

Objective. The purpose of the study was to investigate the clinical effect of radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy. Methods. 80 rectal cancer patients who underwent neoadjuvant therapy in our hospital from February 2016 to February 2018 were selected as the study subjects and divided into the control group (n = 40) and experimental group (n = 40) according to the order of admission. Among them, the control group was treated with radiotherapy, while the experimental group was treated with radiotherapy combined with capecitabine. The therapeutic efficacy, CEA levels, the incidence and recurrence rate of adverse reactions, as well as the progression-free survival and survival rate after 2-year treatment were analyzed in the two groups. Results. The effective rate of treatment in the experimental group of 87.5% (35/40) was significantly higher than 50% (20/40) in the control group, with statistical significance (X2 = 13.09, P < 0.001 ). After treatment, the CEA levels in the two groups both decreased significantly, and the CEA level in the experimental group of 3.75 ± 1.76 ng/ml was significantly lower than 7.35 ± 2.11 ng/ml in the control group, with statistical significance (T = 8.29, P < 0.001 ). The incidence and the recurrence rate of adverse reactions of 5% (2/40) and 10% (4/40), respectively, in the experimental group were significantly lower than those of 40% (16/40) and 30% (12/40) in the control group, with statistical significance (X2 = 14.05, 5.00, P < 0.001 , 0.05). After the 2-year follow-up, it was found that the progression-free survival of 21.53 ± 6.23 months in the experimental group was significantly longer than that of 18.18 ± 5.41 months in the control group, with statistical significance (T = 2.57, P < 0.05 ), and the 2-year survival rate of 97.5% (39/40) in the experimental group was significantly higher than 80% (32/40) in the control group, with statistical significance (T = 6.13, P < 0.05 ). Conclusion. Radiotherapy combined with capecitabine in rectal cancer patients after neoadjuvant therapy can improve the therapeutic efficacy with fewer adverse reactions and longer patients’ survival, which is worthy of popularization and application after neoadjuvant therapy for rectal cancer.

show abstract

“…Thus, benign disease (polyps without submucosal invasion or excisional biopsy for masses of uncertain malignant potential) or uT1 malignant disease with favorable tumor characteristics (no lymphovascular invasion, perineural invasion, or mucinous component) are appropriate [7,8] . TAMIS also has a role in local excision following incomplete polypectomy to provide negative margins, as well as in cases of palliative resection in patients who are unfit for total mesorectal excision (TME) [9] . The quality of local excision appears to be equally achieved as that by TEM [10] .…”

Section: Indications For Tamismentioning

confidence: 99%

Conventional and robotic transanal minimally invasive surgery for rectal neoplasia

Jahansouz¹,

Arsoniadis²,

Sands³

2021

Mini-invasive Surg

View full text Add to dashboard Cite

The treatment of rectal cancer is evolving at a rapid pace in parallel with advancements in surgical technique. One such advancement is the application of the laparoscopic platform to the transanal approach, coined transanal minimally invasive surgery (TAMIS). TAMIS overcomes many of the shortcomings of the traditional transanal approach to the local resection of rectal neoplasia, offering greater visualization and access to the middle and upper rectum with improved oncologic outcomes. Following the introduction of conventional TAMIS, the robotic platform was introduced and applied in analogous fashion. Over the past decade, data have accumulated enabling the comparison of the two approaches most notably with regard to patient morbidity, mortality, and oncologic outcomes. This review discusses the most recently available outcomes regarding conventional and robotic TAMIS and provides a comparison of the two platforms in the treatment of rectal neoplasia. While randomized controlled trials comparing the two platforms are lacking, important differences have been identified. Conventional TAMIS is the more cost-effective approach while advancements in the robotic platform allow the surgeon to be seated and ergonomically optimized, allowing greater visualization and ease of suturing. Differences in oncologic outcomes between the two platforms have not been identified. Head-to-head randomized controlled trials are required to determine if any differences in functional or oncologic outcomes exist.

show abstract

Minimally invasive transanal surgery is safe after incomplete polypectomy of low risk T1 rectal cancer: a systematic review

Cited by 10 publications

References 21 publications

Oncological outcome after local treatment for early stage rectal cancer

Oncological outcome after local treatment for early stage rectal cancer

Clinical Effect of Radiotherapy Combined with Capecitabine after Neoadjuvant Therapy for Rectal Cancer

Conventional and robotic transanal minimally invasive surgery for rectal neoplasia

Contact Info

Product

Resources

About