Surgical resection of rectal adenoma: A rapid review

Casadesús, Damián

doi:10.3748/wjg.15.3851

Cited by 48 publications

(32 citation statements)

References 32 publications

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“…At multivariate analysis, a positive margin was the only factor statistically (p = 0.003) associated with early recurrence. Residual adenoma was found at the surgical margins in 23 (11.1 %) cases, in line with the published data [26]. Reviewing the published data on TEM, residual adenoma is detected in the surgical margins in 0-37 % of cases.…”

Section: Discussionsupporting

confidence: 77%

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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Background Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a "tailored" approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma. Methods This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated. Results Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12-216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4-33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003). Conclusions TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence. Keywords Transanal endoscopic microsurgery Rectal adenoma Recurrence Risk factors Rectal cancer is a common disease in Western countries, with increased incidence in the elderly, males, and obese people [1,2]. Dysplasia precedes the occurrence of invasive rectal cancer [3,4]. Endoscopic detection and removal of rectal adenomas prevents the development of rectal cancer, significantly contributing to the "cure" of the disease [5,6]. Complete resection of the precancerous lesion is mandatory to prevent recurrence. However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.

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Section: Discussionsupporting

confidence: 77%

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

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“…A full-thickness LE can be proposed as a curative surgical procedure only for the treatment of adenomas and selected T1 rectal cancers [81,82]. There is increasing evidence that this approach can be offered also to patients with intraperitoneal rectal cancers, with no increased morbidity and cancer-related mortality [83][84][85][86][87][88].…”

Section: Qualitative Risk Factors and New Biomarkersmentioning

confidence: 99%

“…The depth of submucosal invasion represents one of the most important risk factors for local recurrence and poor survival in patients undergoing LE for ERC [5,77,78,81,82,97,98,100]. One of the main limitations of the preoperative staging is the identification of T1 sm1 rectal cancers [106][107][108].…”

Section: Qualitative Risk Factors and New Biomarkersmentioning

confidence: 99%

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

et al. 2015

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“…Subsequently, operative techniques, such as the Parks excision (16), have progressed. Since its introduction into clinical practice (5), TEM has progressively become the standard for treatment of benign polyps and early neoplasms in TAE (6,7). Currently, the excision of rectal tumors by TEM is associated with fewer surgery-associated morbidities, an improved postoperative anorectal function and a shortened postoperative recovery when compared with open or laparoscopic rectal resections (8,9).…”

Section: Discussionmentioning

confidence: 99%

“…This approach, however, has several limitations, as exposure and visibility within the rectal lumen curtail the surgeon's ability to perform a high-quality oncological excision. Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9).…”

Section: Introductionmentioning

confidence: 99%

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

Noura

Ohue

Miyoshi

et al. 2016

Molecular and Clinical Oncology

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Abstract. Transanal endoscopic microsurgery (TEM) is a minimally invasive technique. However, TEMhas not yet achieved widespread use. Recently, transanal minimally invasive surgery (TAMIS) using single-port surgery devices has been reported. In the present study, TAMIS using a GelPOINT ® Path was performed in six patients with lower rectal cancer. A complete full-thickness excision was performed in all cases. The patient characteristics, operative techniques and operative outcomes were evaluated. The mean age of the patients was 63.0 years (range: 48-76). The mean operating time and blood loss were 86 min (range: 55-110) and 5 ml (range 0-10), respectively. There were no instances of morbidity or mortality. Additional transabdominal rectal resection was not performed, and adjuvant chemoradiotherapy was performed in all cases. The mean Wexner score was 0.6 (range: 0-3; n=5) at 6 months, and 0 (range: 0; n=4) at 12 months. TAMIS using a GelPOINT ® Path was revealed to be easy and safe to perform. Although only a small number of cases were treated, the anal function following surgery was shown to be favorable, and the operation was demonstrated to be sufficiently feasible. Based on these results, TAMIS may, in time, assume a major role in the resection of large adenomas and early rectal cancers. IntroductionThe rectum is a challenging area for surgeons to operate on due to its limited access. Although advances in conventional surgery have broadened the choice of sphincter-preserving procedures, definitive colostomy is still necessary in 10-30% of patients (1). Furthermore, the postoperative morbidity and mortality rates remain high (2). Besides urinary dysfunction, the disturbance of bowel function proves a major problem in ~30% of patients (3,4).Benign neoplasia and early-stage rectal cancer located in the rectum have been traditionally managed with transanal excision (TAE) using a conventional instrument, such as a Parks retractor. This approach, however, has several limitations, as exposure and visibility within the rectal lumen curtail the surgeon's ability to perform a high-quality oncological excision. Since the introduction of transanal endoscopic microsurgery (TEM), which was first described by Buess et al (5), TEM has become the treatment of choice for benign lesions and early-stage cancers that are not suited to TAE using a conventional Parks retractor or flexible endoscope (6,7). TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).Although the instruments and procedures that are used in resection with TEM have remained largel...

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Surgical resection of rectal adenoma: A rapid review

Cited by 48 publications

References 32 publications

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

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