Transanal Endoscopic Microsurgery: A Viable Operative Alternative in Selected Patients With Rectal Lesions

Neary, Paul; Makin, Gregory; White, T. J.; White, Emma E.; Hartley, John E.; MacDonald, A. W.; Lee, P. W. R.; Monson, J. R. T.

doi:10.1245/aso.2003.01.441

Cited by 78 publications

(50 citation statements)

References 25 publications

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“…We were unable to clarify these doubts because we received no reply to our request from the respective study authors. In all, 21 studies met the inclusion criteria for a total of 2,077 patients: 11 ESD series [11][12][13][14][15][16][17][18][19][20][21] totaling 536 patients, and 10 TEM series [2,[22][23][24][25][26][27][28][29][30], totaling 1,541 patients. …”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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“…However, in centres performing high volumes of TEM procedures, the per procedure costs are substantially reduced. 29 …”

Section: Duration Of Surgery Length Of Stay and Costmentioning

confidence: 99%

Transanal endoscopic microsurgery: a review

Heidary

Phang

Raval

et al. 2014

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“…Firstly it allow s access to lesions in the mid and upper rectum. In two series of TEMS resection s most of the lesions would have been too high for a trans anal approach without TEMS, as the mean distance of the lesions from the dentate line was greater than 7 cm (Table 5) [68,69] . Secondly the local recurrence rate after TEMS (5%-9%), is much lower than traditional trans-anal resection (12%-25%) [70] .…”

Section: Transanal Endoscopic Microsurgerymentioning

confidence: 99%

“…We feel that this low recurrence rate is due to the technique, as the rectum is constantly dilated by insufflation of CO 2 gas, enabling more precise surgery. Table 5 TEMS excision of benign lesions [68,69] Lev-Chelouche Neary Number 46 21 Distance from dentate line (cm) 3-18 (mean 7)…”

Section: Transanal Endoscopic Microsurgerymentioning

confidence: 99%

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The impact of new technology on surgery for colorectal cancer

Makin¹,

Breen²,

Monson³

2001

WJG

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Advances in technology continue at a rapid pace and affect all aspects of life, including surgery. We have reviewed some of these advances and the impact they are having on the investigation and management of c o l o r e c t a l c a n c e r . M o d e r n e n d o s c o p e s , w i t h magnifying, variable stiffness and localisation capabilities are making the primary investigation of colonic cancer easier and more acceptable for patients. Imaging investigations looking at primary, metastatic and recurrent disease are shifting to digital data sets, which can be stored, reviewed remotely, potentially fused with other modalities and reconstructed as 3 dimensional (3D) images for the purposes of advanced diagnostic interpretation and computer assisted surgery. They include virtual colonoscopy, trans-rectal ultrasound, magnetic resonance imaging, positron emission tomography and radioimmunoscintigraphy. Once a colorectal carcinoma is diagnosed, the treatment options available are expanding. Colonic stents are being used to relieve large bowel obstruction, either as a palliative measure or to improve the patient's overall condition before definitive surgery. Transanal endoscopic microsurgery and minimally invasive techniques are being used with similar outcomes and a lower mortality, morbidity and hospital stay than open trans-abdominal surgery. Transanal endoscopic microsurgery allows precise excision of both benign and early malignant lesions in the mid and upper rectum. Survival of patients with i n o p e r a b l e h e p a t i c m e t a s t a s e s f o l l o w i n g radiofrequency ablation is encouraging. Robotics and telemedicine are taking surgery well into the 21 st century. Artificial neural networks are being developed to enable us to predict the outcome for individual patients. New technology has a major impact on the way we practice surgery for colorectal cancer.Subject headings colorectal neoplasms; technology; surgery; radiology

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Transanal Endoscopic Microsurgery: A Viable Operative Alternative in Selected Patients With Rectal Lesions

Cited by 78 publications

References 25 publications

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Transanal endoscopic microsurgery: a review

The impact of new technology on surgery for colorectal cancer

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