Transanal endoscopic microsurgery for advanced polyps and early cancers in the rectum—Long-term outcome

Abstract

Transanal endoscopic microsurgery (TEM) allows for the resection of large adenomas and early stage cancers in the rectum. The rate of complications and recurrence for malignant tumors compared with benign tumors has been questioned.The objective of our study was to analyze the outcome after TEM procedures for adenomas and cancers with focus on local recurrence and complications.All 280 patients who had a TEM procedure between January 2008 and September 2015 were enrolled in a prospective cohort study. Outcome was described for benign and malignant tumors. Mortality, recurrence, and complications were recorded.Two hundred eighty tumors were treated with TEM, 176 (63%) were benign and 104 (37%) were malignant. Complication rates were significantly different in the 2 groups, 10.8% (n = 19) in the benign and 24.0% (n = 25) in the malignant group (P = 0.003). A significant difference in perforation/penetration to the peritoneal cavity was noted (P = 0.034). There were no significant difference in the recurrence rate of 8.3% (n = 13) in the benign and 9.0% (n = 7) in the malignant groups. Thirty days mortality rates were 1.1% in the benign group versus 1.9% in the malignant. Other complications were noted in 2.8% and 3.8% in the benign and malignant group, respectively.TEM seems to be a safe and viable procedure for removing both benign and malignant lesions from the rectum. TEM offers low mortality and complication rates also recurrence after resection of malignant tumors.

Timing of recurrences of TEM resected rectal neoplasms is variable as per the surveillance practices of one tertiary care institution

“…Of those 4 patients recurred, representing a recurrence rate of 16% in this population of T1 and T2 lesions. Our recurrence rates are similar to that of many studies, which range from 4.7 to 26% depending on T stage 19 – 22 . Baatrup et al demonstrated a recurrence rate of 18% for patients with adenocarcinoma treated with TEM.…”

“…Of note is the fact that our latest recurrence was caught at 16.9 months, however this patient did not have their first post-surgical endoscopic surveillance visit until 16.9 months, thus the recurrence may have been caught earlier had the patient been scoped at 6 and 12 months. Studies show similar recurrence rates ranging from 2.4%-10.5% as that seen in our adenoma patients 18 , 19 . A study by Barendse et al showed that in benign lesions excised by TEM, larger size (> 3 cm) was a significant factor for recurrence and the median time to recurrence was 10 months 23 .…”

“…The focus of our study was on endoscopic surveillance practices post TEM and recurrence patterns in benign and malignant lesions, at our institution. The demographics of our patients, tumour characteristics, surgical results and outcomes are similar to other studies on TEM for benign and malignant lesions [17][18][19][20][21][22] . Although there is currently no established standardized protocol for endoscopic surveillance of patients post-TEM at our institution, the majority of the patients had their endoscopy within the timeframes of the commonly quoted surveillance recommendation from the clinic notes, namely every 6 months for 2 years.…”

Modern management of T1 rectal cancer by transanal endoscopic microsurgery: a 10‐year single‐centre experience

“…Several institutions have published papers over the last year describing outcomes after TEM for rectal cancer, with local recurrence rates around the 5%−10% range. A paper reporting on results from two centres in Denmark over an 8‐year period presented 104 TEM procedures for cancer, although the tumour stage is not given. ‘Radical resection’ of the tumour in the TEM specimen was reported by the pathologist in 57 (55%), but the definition of ‘radical resection’ and the rate of involved margin are not provided.…”

Initial application of transanal endoscopic microsurgery for high-risk lower rectal gastrointestinal stromal tumor after imatinib mesylate neoadjuvant chemotherapy

“…Compared with the APR and some other function-preserving procedures, TEM is much more minimally invasive with less morbidity and better life quality for selective patients. [ 16 ] Lower rectal GIST is a rare entity consisting of less than 1% of GIST originated from gastrointestinal tract. GIST is a kind of heterogeneous tumor that should be stratified to different risk levels, ranging from very low risk, low risk, intermediate risk to high risk, according to the tumor size, tumor location, and activity of mitosis.…”