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

Abstract

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.

Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

“…Additional risks communicated to patients include anal incontinence, rectal stenosis and rectovaginal fistula and no patients in this study experienced these complications. Overall, our complication rate was 8.5% which is significantly lower than the 50% reported with radical surgery and comparable with previous reports for TEM in the literature (5–21%) .…”

Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients

“…A survey of recent publications suggests that admission to hospital is still common, with most series reporting a minimum hospital stay of of 1 day (see Table ) . However, Laliberte et al .…”

“…A survey of recent publications suggests that admission to hospital is still common, with most series reporting a minimum hospital stay of of 1 day (see Table 4) [10][11][12][13][14]18,19]. However, Laliberte et al and Lee et al report outpatient surgery in 80% and 76% of their TEM/TAMIS patients, respectively [4,6].…”

Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis

“…For decades, there has been an increasing prevalence of CRC in Lithuania [2]. This was the reason for searching for the most optimal way of treatment that could not only assure a longer life span but which would also avoid a decrease of the patients' quality of life.…”

“…These postoperative complications have a major impact on the patients' quality of life, whereas TEM is associated with low morbidity and mortality [7,8,9,10]. However, local recurrence after TEM is a major problem in up to 24% of patients treated for rectal cancer by this method [2,11,12,13,14,15]. If a more advanced cancer stage (more than pT1 sm1) is found in TEM specimen or if the tumour is poorly differentiated, a salvage TME (sTME) procedure is indicated in these patients [16].…”