Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Amann, Michael; Modabber, Ali; Burghardt, Jens; Stratz, Christian; Falch, Claudius; Bueß, G.; Kirschniak, Andreas

doi:10.1186/1477-7819-10-255

Cited by 19 publications

(20 citation statements)

References 27 publications

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“…66 TES was quickly applied to T1 rectal tumors, as well as to advanced lesions in patients unable to tolerate radical resection. [67][68][69][70][71] TES has the same limitations as TAE, including high recurrence rates for more advanced tumors and tumors with high-risk histological features. 72,73 Nevertheless, in carefully selected T1 cancers, local recurrence rates for TES are similar to those for TME; 0-5% in T1 sm1/sm2 cancers, but up to 10-12% in T1 sm3 cancers.…”

Section: Transanal Endoscopic Surgerymentioning

confidence: 99%

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.

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Section: Transanal Endoscopic Surgerymentioning

confidence: 99%

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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“…TEMS generally offers advantages in operative access and oncological clearance over transanal resection (TAR), but recently a number of similar logic techniques with various rectal ports for endoscopic excision of rectal tumours has been invented. Those methods are collectively named transanal minimal-invasive surgery (TAMIS) and for oncological purposes they share the same features of local excision as TEMS (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

mentioning

confidence: 99%

“…Some studies support that there is potentially a higher risk of local recurrence rate with TEMS (8,10,18). Efforts have been made to classify risk with morphological and histological criteria with better patients' selection (1,(6)(7)(8)(9); however, the risk stratification remains imperfect. Molecular biomarkers have been used in prognosis of colorectal cancer (CRC) in general and rectal cancer seems to follow the same genetic phenotype (19).…”

mentioning

confidence: 99%

KRAS Mutant Status, p16 and β-catenin Expression May Predict Local Recurrence in Patients Who Underwent Transanal Endoscopic Microsurgery (TEMS) for Stage I Rectal Cancer

Sideris

Moorhead

Díaz‐Cano

et al. 2016

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Abstract. Background The method of local excision, that has recently, gained wider acceptance, in early rectal cancer, is transanal endoscopic microsurgery (TEMS). TEMS generally offers advantages in operative access and oncological clearance over transanal resection (TAR), but recently a number of similar logic techniques with various rectal ports for endoscopic excision of rectal tumours has been invented. Those methods are collectively named transanal minimal-invasive surgery (TAMIS) and for oncological purposes they share the same features of local excision as TEMS (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).TEMS is a minimally invasive technique that was introduced by Buess in the early 1980's (2). Through the new rectoscope with 3D binocular optic and the endoscopic instruments, it offers better access to proximal lesions with lower margin positivity and fragmentation and magnification of the operative field (2, 15). TEMS is a safe procedure that offers low complication rates and peri-operative morbidity (10.7%) (4). There have been multiple studies to suggest that TEMS is the operation of choice for rectal adenomas (1), retrorectal and submucosal rectal lesions (5). Furthermore, TEMS offers the advantage of not damaging the anorectal function (7).TEMS is indicated as a curative treatment for malignant neoplasms that are histologically confirmed as pT1 sm1 carcinomas, whereas T1 sm2-3 and T2 lesions are still under question (8). A number of studies have shown that TEMS can have comparable results with radical surgery (1,8,12,16) for rectal cancer.There has been concern about oncologic outcomes following TEMS (17). Some studies support that there is potentially a higher risk of local recurrence rate with TEMS (8,10,18). Efforts have been made to classify risk with morphological and histological criteria with better patients' selection (1, 6-9); however, the risk stratification remains 5315

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“…A total of 144 patients had a rectal adenoma (n = 103) or an R0 resection of low-risk T1 carcinomas (n = 41) in the postoperative histological findings. We have already published these data [6].…”

Section: Patientsmentioning

confidence: 90%

“…However, after the treatment of carcinomas with local excision via transanal endoscopic microsurgery (TEM), relatively unacceptable recurrence rates are reported [5]. Whereas transanal endoscopic microsurgery has a confirmed place in the surgical treatment of adenomas [6], its potential use for selected patients as an operative method of choice in the treatment of T1 high-risk, T2 and T3 carcinomas is under debate. Some authors conclude that TEM in combination with radiochemotherapy used for carefully chosen 1 3 patients can lead to comparable long-term results [7,8].…”

Section: Introductionmentioning

confidence: 99%

Transanal endoscopic microsurgery in treatment of small rectal T1 high-risk, T2 and T3 carcinomas combined with radiochemotherapy

Amann

Burghardt²,

Stratz

et al. 2015

Eur Surg

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Original Article226 Transanal endoscopic microsurgery in treatment of small rectal T1 high-risk, T2 and T3 carcinomas combined 1 3 SummaryBackground The present survey evaluates the value of TEM in the treatment of small T1 high-risk, T2 and T3 carcinomas in combination with neoadjuvant or adjuvant therapy or without radiochemotherapy.Methods In this retrospective survey, patient data from 86 patients suffering from T1 high-risk, T2 or T3 carcinoma was reviewed.Results Overall, Patients with T1 high-risk carcinoma showed a recurrence rate of 12.5 % (n = 16). The recurrence rate of T2 low-risk carcinomas was 11.1 % (n = 36), and of T2 high-risk carcinomas was 31.3 % (n = 17). Patients who had suffered a T3 low-risk carcinoma showed a recurrence rate of 0 % (n = 5). In the group of patients with T3 high-risk carcinomas, 16.7 % (n = 12) showed a recurrence.Conclusions An analysis of the different subgroups has shown that after successful downstaging with neoadjuvant radiochemotherapy, TEM is a curative treatment alternative for T2 low-risk carcinomas. It seems that the degree of downstaging has an effect on the prognosis with regard to the appearance of a local recurrence. The effect of downstaging of T2 low risk carcinomas can possibly be applied to T3 low-risk carcinomas. In the case of high-risk carcinomas, TEM can only be a treatment alternative for comorbid patients or a method for palliation. Original ArticleTransanal endoscopic microsurgery in treatment of small rectal T1 high-risk, T2 and T3 carcinomas combined 227

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Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

Cited by 19 publications

References 27 publications

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

KRAS Mutant Status, p16 and β-catenin Expression May Predict Local Recurrence in Patients Who Underwent Transanal Endoscopic Microsurgery (TEMS) for Stage I Rectal Cancer

Transanal endoscopic microsurgery in treatment of small rectal T1 high-risk, T2 and T3 carcinomas combined with radiochemotherapy

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