Transanal Endoscopic Microsurgery in Small, Large, and Giant Rectal Adenomas

Abstract

To assess the outcomes of transanal endoscopic microsurgery in small (Ͻ3 cm), large (3-5 cm), and giant (Ͼ5 cm) lesions and compare these with reports of alternative techniques. Design: Data from January 1998 to February 2010 were prospectively collected. Lesions were divided into 3 groups according to the maximum diameter (group A, Ͻ3 cm; group B, 3-5 cm; and group C, Ͼ5 cm) and outcomes were analyzed separately. Setting: Colorectal unit in a single-district general hospital. Patients: Patients diagnosed as having benign rectal adenomas.

Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indications among 168 consecutive patients

“…The most common complication, rectal bleeding, is in line with the report of Allaix et al [30], who reported a postoperative haemorrhage rate (requiring blood transfusion, endoscopic haemostasis or rectal packing) in 8% of 300 patients [30]. The rate of peritoneal perforation in the present study (15%) is high when compared with the literature, where rates range from 0-10% [25,[27][28][29]31,32], but this is likely to be due to the high proportion (18%) of tumours in the upper rectum. Our aggressive policy of laparoscopic conversion whenever a perforation was suspected allowed safe suturing of the defect, with only four patients requiring a temporary diverting stoma.…”

“…In the case of R1 resection of an adenoma, however, we carry out a simple follow‐up with any future action as appropriate, to avoid a TME with its risk of morbidity and dysfunction. This policy has led to the satisfactory long‐term incidence of local recurrence of only 7%, which compares favourably with other reports .…”

“…The overall R1 resection rate of 12% was similar to that reported by Scala et al . of 10% among 320 patients having TES. We have a policy of recommending a salvage TME after TES for any R1 resection of an adenocarcinoma or for a lesions subsequently staged by the pathologist as T1sm2 or more.…”

“…However, this runs the risk of jeopardizing the short‐ and long‐term results, and the technical limits of TES have not yet been clearly defined. Although no maximal size has been regarded as a contraindication to TES, several studies have shown that large adenomas (> 3–5 cm) were associated with a higher risk of incomplete resection . A tumour occupying more than half of the rectal circumference is technically difficult to handle and might be associated with piecemeal resection, and a tumour in the upper rectum might increase the chance of perforation into the peritoneal cavity .…”

Tratamento da neoplasia retal pela microcirurgia endoscópica transanal- TEM: fatores de risco para complicações pós-operatórias

“…Este achado ocorreu, talvez, pelo fato de valorizar-se mais intensamente a incontinência e urgência evacuatória, ou talvez, pelo fato de estarem em região anatômica responsável pela continência. A literatura é inconclusiva neste sentido onde lesões mais proximais por vezes complicam mais (68,149) , por vezes são as mais distais que têm tratamento mais dificultoso e complicam mais (50,151) , e em alguns outros casos não chega a ser considerado fator de risco (202) .…”