Transanal endoscopic microsurgery: a review

Heidary, Behrouz; Phang, Terry; Raval, Manoj J.; Brown, C. J.

doi:10.1503/cjs.022412

Cited by 54 publications

(60 citation statements)

References 128 publications

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“…TEM alone is not acceptable treatment option for fit patients with rectal cancer of local stage T2 or deeper [79] . CRT after local excision presented disappointing results, since local recurrence rate has been reported as high as 45% [91] .…”

Section: Long-term Results Studies On the Oncological Outcome Followimentioning

confidence: 99%

“…CRT after local excision presented disappointing results, since local recurrence rate has been reported as high as 45% [91] . However, TEM after neoadjuvant CRT for downstaging of advanced tumors has been investigated demonstrating promising results [79] . Lezoche et al [92] prospectively randomized 70 patients with T2N0 rectal cancers to either TEM (n = 35) or laparoscopic radical resection (n = 35) after CRT.…”

Section: Long-term Results Studies On the Oncological Outcome Followimentioning

confidence: 99%

“…The overall complication rate for TEM has been reported between 6% and 31%, with an equal distribution between benign and malignant disease [79] . Perioperative complications include hemorrhage and intraperitoneal perforation (0%-9%), which both may require conversion to laparotomy [79] . Postoperative hemorrhage has been reported in 1% to 13% of patients.…”

Section: Early Post-operative Outcomementioning

confidence: 99%

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Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

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Section: Long-term Results Studies On the Oncological Outcome Followimentioning

confidence: 99%

Section: Long-term Results Studies On the Oncological Outcome Followimentioning

confidence: 99%

Section: Early Post-operative Outcomementioning

confidence: 99%

See 1 more Smart Citation

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

View full text Add to dashboard Cite

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“…34 This can be further categorized into low-risk T1 adenocarcinomas of the rectum, which are characterized as small (< 4 cm), well differentiated tumors without lymphatic, vascular or perineural involvement. 35 For patients with poor histologic features (lymphovascular or perineural invasion, poor differentiation, tumor budding), discussion at a multi-disciplinary tumor board should ensue to reach a consensus on subsequent treatment. T1 cancers with deeper submucosal invasion (sm2 or sm3) as determined by the Kikuchi classification of sessile lesions may confer metastatic potential to lymph nodes and should essentially be treated as a T2 lesion.…”

Section: B Patient Selectionmentioning

confidence: 99%

Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

2017

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Teresa deBeche-Adams, Imran Hassan, and the SAGES Guidelines Committee PreambleThe following clinical spotlight review regarding Transanal Minimally Invasive Surgery (TAMIS) is intended for physicians who manage and treat rectal pathology. It is meant to critically review this technique and the available evidence supporting its safety and efficacy. Based on the level of evidence, recommendations may or may not be given for its use in clinical practice. DisclaimerGuidelines for clinical practice and spotlight reviews are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Spotlight reviews are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests, and are intended to convey recommendations based on a focused topic; within the defined scope of the review, they indicate the preferable, but not necessarily the only acceptable approaches due to the complexity of the healthcare environment. Guidelines and recommendations are intended to be flexible. Given the wide range of specifics in any healthcare problem, the surgeon must always choose the course best suited to the individual patient and the variables in existence at the moment of decision. Guidelines, spotlight reviews, and recommendations are developed under the auspices of the Society of American Gastrointestinal Endoscopic Surgeons and its various committees, and approved by the Board of Governors. Each clinical spotlight review has been systematically researched, reviewed and revised by the guidelines committee, and, when appropriate, reviewed by an appropriate multidisciplinary team. The recommendations are therefore considered valid at the time of production based on the data available. Literature reviewA systematic literature search was performed using PubMed for Transanal Minimally Invasive Surgery (TAMIS). The literature was reviewed from September 1, 2010 through May 31, 2016. Both the quality of the evidence and the strength of the recommendation for each of the guidelines were assessed according to the GRADE system. This uses a 4-tiered system for denoting the quality of evidence (very low (+), low (+ +), moderate (+ + +), or high (+ + + +)) and a 2-tiered system for strength of recommendation (weak, or strong).

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“…The patients were selected according to the previously mentioned indications for local excision 7 . We also included patients with T1 lesions exhibiting lymphovascular invasion and those with T2 or T3 tumors who refused or could not tolerate radical surgery due to frailty.…”

Section: Patient Selectionmentioning

confidence: 99%

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

et al. 2016

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PURPOSE:In this paper we report the oncological outcomes from clinical series of patients with rectal cancer submitted to local excision after neoadjuvant therapy and discuss the indications for local excision in partial clinical responders. METHODS:We analysed a prospective database of 39 patients submitted to a transanal endoscopic operation for rectal cancer after neoadjuvant chemoradiation between 2006 and 2015, comparing clinical and pathological variables, perioperative complications, recurrence rate and overall survival. RESULTS:We obtained 15.4% ypT0, 17.9% ypT1, 35.9% ypT2 and 28.2% ypT3. After a median follow-up of 24 months, tumoral recurrence was observed in 4 patients, one of them with isolated pulmonary metastasis. R0 resection was achieved in 79.5%, and postoperative complications were observed in 30.2% patients and no perioperative mortality occur. Compromise surgical margins do not affect recurrence rate, and 94.9% of patients are alive nowadays. CONCLUSION:Local excision could be associated with low recurrence rate and good overall survival. Short hospitalization time and low level of serious complications observed could be an interesting option for patients who would not tolerate a radical procedure or for those who declined a total mesorectal excision. A strict long-term follow-up must be warranted to detect early tumoral recurrence.

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Transanal endoscopic microsurgery: a review

Cited by 54 publications

References 128 publications

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Transanal Minimally Invasive Surgery (TAMIS): a clinical spotlight review

Transanal endoscopic operation for rectal cancer after neoadjuvant therapy

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