Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection

Langer, Claus; Liersch, Torsten; Süß, Markus; Siemer, Alexander; Markus, Peter M.; Ghadimi, B. M.; Füzesi, L.; Becker, H. D.

doi:10.1007/s00384-002-0441-4

Cited by 153 publications

(95 citation statements)

References 23 publications

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“…These known advantages of TEM, particularly as compared with the radical surgical procedure, were confirmed by our study [29]. Moreover, this study performed in a larger collective confirms that TEM-induced lesser blood loss decreases postoperative risk [12] and also confirms the shortened duration of hospital stay following local excision [30]. This is very important, especially from a financial point of view.…”

Section: Discussionsupporting

confidence: 84%

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Amann

Modabber

Burghardt³

et al. 2012

World J Surg Onc

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BackgroundTransanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter. The present retrospective analysis reports the course of observation after local excision of adenomas and T1 low-risk carcinomas using transanal endoscopic microsurgery.MethodsIn a retrospective analysis we examined data on 279 patients for local recurrence. A total of 144 patients had a rectal adenoma (n = 103) or a R0 resection of low-risk T1 carcinomas (n = 41). In this collective, we also examined parameters concerning perioperative management, complications, intraoperative blood loss and duration of hospital stay.ResultsPatients with adenoma were on average 64.9 (range 37 to 90) years old; 83.5% of the adenomas were located 3 to 11 cm from the anocutaneous line. In adenoma patients the recurrence rate was 2.9% for an observation period of 21.8 months. The postoperative course was without any complications in 98.1% of patients.Patients with T1 low-risk carcinoma were 64.6 (range 30 to 89) years old. In all cases, an R0 resection could be performed. The recurrence rate was 9.8% for an observation period of 34.4 months. In this group the postoperative course was free of complications in 97.6% of patients.ConclusionsThe high efficacy of transanal endoscopic microsurgery ensures minimally invasive treatment of adenomas and low-risk T1 carcinomas with low complication rates and a low rate of therapeutic failure.

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Section: Discussionsupporting

confidence: 84%

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Amann

Modabber

Burghardt³

et al. 2012

World J Surg Onc

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“…Various articles demonstrating different postoperative morbidity rates ranging from 11.8% to 17% for local excision (LE) [910], 7.7%, to 21% for TEM [1112], and 18% to 55% for a radical resection [913] have been published. The study of de Graaf et al [14] was the first to find statistically significant differences when comparing the safeties of LE and TEM; they reported postoperative mortality rates of 5.3% and 10% after TEM and LE, respectively.…”

Section: Discussionmentioning

confidence: 99%

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

et al. 2017

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PurposeThe purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM).MethodsOur study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences.ResultsThe average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days.ConclusionTEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

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“…For instance, Langer et al retrospectively compared the long-term outcomes of 54 patients undergoing conventional TE and 57 patients undergoing a TEM procedure for rectal adenoma [24]. They reported a significantly higher local recurrence rate after TE than after TEM (31.5 vs 8.8%, respectively).…”

Section: Current Indicationsmentioning

confidence: 99%

Transanal endoscopic microsurgery: what indications in 2013?

Morino

Allaix

2013

Gastroenterology Report

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Thanks to major advances in the field of surgical techniques and neoadjuvant chemoradiation therapy, along with more accurate pre-operative staging tools and the widespread introduction of population-based screening programs, treatment of rectal cancer has been evolving over the past few decades, moving towards a more tailored approach. This has brought a shift in the treatment algorithm of benign rectal lesions and selected early rectal cancers, for which today transanal endoscopic microsurgery (TEM) is accepted as an effective alternative to abdominal surgery.In 2013, topics of controversy are the role of TEM in the treatment of more advanced rectal cancers, in cases of complete pathological response after chemoradiation therapy and the role of TEM as a platform for single-port surgery and NOTES. This article reviews the current indications for TEM and the future perspectives of this approach in the treatment of rectal tumors.

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Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection

Cited by 153 publications

References 23 publications

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

Transanal endoscopic microsurgery: what indications in 2013?

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Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection

Cited by 153 publications

References 23 publications

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution&apos;s Experience

Transanal endoscopic microsurgery: what indications in 2013?

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Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience