Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course

Marques, Carlos Frederico Sparapan; Nahas, Caio Sérgio Rizkallah; Ribeiro, Ulysses; Bustamante, Leonardo; Pinto, Rodrigo Ambar; Mory, Eduardo K.; Cecconello, Ivan; Nahas, Sérgio Carlos

doi:10.1007/s00384-016-2527-4

Cited by 16 publications

(9 citation statements)

References 41 publications

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“…This is a safe procedure, with a mortality rate of practically zero and morbidity rates between 4% and 29% , rising to 50% in some series . The most frequent complications are bleeding, acute urine retention, sepsis and need for conversion to laparotomy . None of the patients in our series died within the first 30 days after surgery.…”

Section: Discussionmentioning

confidence: 57%

“…For the pathologist to be able to perform a proper study of the rectal wall, the resection by TEM should be a full-thickness wall resection. This is a safe procedure, with a mortality rate of practically zero [33] and morbidity rates between 4% and 29% [34][35][36], rising to 50% in some series [33]. The most frequent complications are bleeding, acute urine retention, sepsis and need for conversion to laparotomy [26,33,34].…”

Section: Discussionmentioning

confidence: 99%

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Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins

et al. 2018

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins

et al. 2018

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“…19 The reported overall morbidity in the literature is 0-21%. [20][21][22] this meta-analysis demonstrated no statistically significant difference in postoperative infection between the sutured and open groups (3.53% and 1.84%, p = 0.27). Infection rates correspond to reported rates in the literature between 1% and 10%.…”

Section: Discussionmentioning

confidence: 81%

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

Khan

Hunter

Manzoor

2020

annals

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Introduction Management of the rectal defect following transanal endoscopic microsurgery (TEMS) or minimally invasive surgery (TAMIS) carried out for excision of neoplasm in the lower rectum is controversial. We aimed to extract evidence by carrying out a meta-analysis to compare the peri- and postoperative outcomes following rectal neoplasm excision carried out by TEMS and/or TAMIS, whereby the defect is either sutured or left open. Methods A literature search of Ovid MEDLINE and EMBASE was performed. Full-text comparative studies published until November 2019, in English and of adult patients, whereby TEMS or TAMIS was undertaken for rectal neoplasms were included. The main outcome measures were postoperative bleeding, infection, operative time and hospital stay. Findings Three studies (one randomised controlled trial and two comparative case series) yielded 555 cases (283 in the sutured group and 272 in the open group). The incidence of postoperative bleeding was higher and statistically significant (p = 0.006) where the rectal defect was left open following excision of the neoplasm (19/272, 6.99% vs 6/283, 2.12%). There was no statistical difference between the sutured and open groups regarding infection (p = 0.27; (10/283, 3.53% vs 5/272, 1.84%, respectively), operative time (p = 0.15) or length of stay (p = 0.67). Conclusion Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open. However, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.

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“… 48 It has been established that a preoperative CRT and more distal lesions lead to more issues with functional outcomes, but fortunately, these complications are usually self-limiting. 49 The trials included in this meta-analysis did report on rectal pain and anal incontinence, but the occurrence of LARS as a long-term complication was not reported in any of the publications.…”

Section: Discussionmentioning

confidence: 98%

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

et al. 2021

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Background Transanal endoscopic microsurgery (TEMS) has been suggested as an alternative to total mesorectal excision (TME) in the treatment of early rectal cancers. The extended role of TEMS for higher stage rectal cancers after neoadjuvant therapy is also experimented. The aim of this meta-analysis was to compare the oncological outcomes and report on the evidence-based clinical supremacy of either technique. Methods Medline, Embase, and Cochrane databases were searched for the randomized controlled trials comparing the oncological and perioperative outcomes of TEMS and a radical TME. A local recurrence and postoperative complications were analyzed as primary end points. Intraoperative blood loss, operation time, and duration of hospital stay were compared as secondary end points. Results There was no statistical difference in the local recurrence or postoperative complications with a risk ratio of 1.898 and 0.753 and p-values of 0.296 and 0.306, respectively, for TEMS and TME. A marked statistical significance in favor of TEMS was observed for secondary end points. There was standard difference in means of −4.697, −6.940, and −5.685 with p-values of 0.001, 0.005, and 0.001 for blood loss, operation time, and hospital stay, respectively. Conclusion TEMS procedure is a viable alternative to TME in the treatment of early rectal cancers. An extended role of TEMS after neoadjuvant therapy may also be offered to a selected group of patients. TME surgery remains the standard of care in more advanced rectal cancers.

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Postoperative complications in the treatment of rectal neoplasia by transanal endoscopic microsurgery: a prospective study of risk factors and time course

Abstract: Postoperative complications after transanal endoscopic microsurgery for the treatment of rectal neoplasia are frequent, acceptable, and usually controllable with pharmacologic treatment. Over time the nature of complications is continuous, centered on the first 20 days after surgery.

Cited by 16 publications

References 41 publications

Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins

Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A meta-analysis

A Meta-analysis of Transanal Endoscopic Microsurgery versus Total Mesorectal Excision in the Treatment of Rectal Cancer

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