Risk factors and treatment of rectal stenosis after transanal endoscopic microsurgery

Liu, Ran; Yan, Chuan-wang; Shang, Wei; Yuan, Wenguang; Liang, Hao; Zhai, Jiancheng; Wen, Liang; Yang, Hui; Xia, Ling

doi:10.1111/codi.15904

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…The patients refused the recommended repeat TEM surgery or radical surgery and received postoperative adjuvant therapy. Although the anorectal function after repeated TEM is preserved ( 50 ), many factors including malignant lesions ( 51 , 52 ), excessive circumferential mucosal defects ( 53 ), and closer proximity of the tumor to the anal verge suggest a higher risk of impaired anal function after TEM.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

Zhang

Jing

et al. 2022

Front. Oncol.

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AimTransanal endoscopic microsurgery (TEM) is widely performed in early rectal cancer. This technique offers greater organ preservation and decreases the risk of subsequent surgery. However, postoperative local recurrence and distant metastasis remain challenges for patients with high-risk pathological factors. This single-center study reports the prognosis of early rectal cancer patients over 60 years old after TEM.MethodsThe data of the patients over 60 years old who underwent local anal resection were collected retrospectively. Moreover, the 5-year follow-up data were analyzed to determine the 5-year DFS and OS.Results47 early rectal cancer patients over 60 years old underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors. Two patients underwent radical surgery after TEM and ten patients received adjuvant treatment. Local recurrence occurred in 7 patients, of which 4 underwent salvage surgery. The 5-year progression-free survival rate was 75.6%, which was lower in the high-risk patients group (69.6%) than in the non-high-risk patients group (83.3%) (P>0.05). The 5-year OS was 90.2%, but there was no statistically significant difference between the two groups (high-risk patients 87.0%, non-high-risk patients 94.4%). Furthermore, there was no significant difference in DFS and OS between people over and under 70 years old.ConclusionSome high-risk factor patients over 60 years old do not have inferior 5-year DFS and OS to the non-high-risk patients. TEM is an option for old patients with high surgical risks. Even if postoperative pathology revealed high-risk factors, timely surgical treatment after local recurrence would be beneficial to improve the 5-year DFS and OS.

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Section: Discussionmentioning

confidence: 99%

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

Zhang

Jing

et al. 2022

Front. Oncol.

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Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study

Wang,

Wang

et al. 2023

Langenbecks Arch Surg

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Local Excision for the Management of Early Rectal Cancer

Quaresima¹,

Palmieri²,

Balla³

et al. 2024

Current Concepts and Controversies in Laparoscopic Surgery

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Transanal endoscopic microsurgery (TEM) is a minimally invasive technique introduced in the 1980s to overcome the technical difficulties in the management of low rectal tumors. The TEM system includes a dedicated rigid rectoscope and platform with a dedicated expensive instrumentation. The transanal minimally invasive surgery (TAMIS) technique was introduced to overcome these limitations. Transanal surgery consists of three main steps: exposure of the lesion, tumor excision, and defect closure. Traditional indications are benign adenomas and selected T1 rectal cancers. However, when combined with neoadjuvant chemoradiotherapy (n-CRT), the indications may be extended to patients with selected T2-T3 rectal cancers responsive to n-CRT. Intraoperative complications may be difficult to deal with, but peritoneal entry is adequately managed by endoluminal direct closure of the defect by expert surgeons. Concerning the indications for defect closure, there is no evidence of better results to prevent complications such as bleeding; the indication for defect closure should be evaluated according to multiple variables. The management of other complications is safe and does not affect TEM’s oncological and functional outcomes. Transanal excision of rectal tumor is a safe and effective alternative to conventional resection to avoid the low anterior resection syndrome, with comparable oncological results and with the advantages of an organ-sparing strategy for better patients’ QoL.

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Risk factors and treatment of rectal stenosis after transanal endoscopic microsurgery

Cited by 3 publications

References 23 publications

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience

Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study

Local Excision for the Management of Early Rectal Cancer

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