Article

Allaix ME, Arezzo A, Caldart M, Festa F, Morino M. Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases

Center for Minimally Invasive Surgery, Dipartimento di Discipline Medico Chirurgiche, Università di Torino, 10126 Torino, Italy.
Diseases of the Colon & Rectum (Impact Factor: 3.2). 11/2009; 52(11):1831-6. DOI: 10.1007/DCR.0b013e3181b14d2d
Source: PubMed

ABSTRACT Abdominal resection for rectal neoplasms is associated with significant morbidity. Local excision with retractors can be proposed only for distal rectal lesions. With this retrospective review of our prospective series of transanal endoscopic microsurgery procedures, we wanted to verify the advantages of local treatment in terms of disease recurrence and complication rates.
Indications for transanal endoscopic microsurgery were adenoma, early carcinoma, rectal ulcers, carcinoid tumors, gastrointestinal stromal tumors, and leiomyosarcoma apparently located in the extraperitoneal rectum. We analyzed operating time, morbidity and mortality rates, length of hospital stay, staging discrepancy, recurrence rate, and oncological outcome.
From January 1993 to January 2007, 300 patients underwent transanal endoscopic microsurgery at our institution. The mean operating time was 66 minutes. The peritoneum was inadvertently opened in 13 cases. The overall morbidity rate was 7.7%. The mean hospital stay was five days. Histology demonstrated cancer in 90 patients. At a mean follow-up of 60 months, the recurrence rate was zero in pT1, 24% in pT2, and 50% in pT3. The overall estimated five-year survival rate was 87%, and the disease-free survival rate was 82%.
Transanal endoscopic microsurgery is safe and effective in the treatment of adenoma and pT1 carcinoma; it carries a lower morbidity than conventional surgery and a recurrence rate comparable to that of conventional surgery.

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Available from: Marco Ettore Allaix, Mar 24, 2015
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    • "In similar large benign lesions removed by either TEMS or endoscopic mucosal resection (EMR), anal resting pressures are lower after TEMS excision, but continence in patients with a large rectal adenoma are improved after EMR or TEMS [13]. Morbidity from TEMS has been shown to range from 7.7% [14] to 21% [15] with the commonest reported problems being urinary retention, suture line dehiscence and bleeding. Entry into the peritoneal cavity occurs in 5.8% of cases and is associated with higher anterior tumours [16]. "
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    ABSTRACT: Transanal endoscopic microsurgery (TEMS) is a well established method of accurate resection of specimens from the rectum under binocular vision. This review examines its role in the treatment of benign conditions of the rectum and the evidence to support its use and compliment existing endoscopic treatments. The evolution of TEMS in early rectal cancer and the concepts and outcomes of how it has been utilised to treat patients so far are presented. The bespoke nature of early rectal cancer treatment is changing the standard algorithms of rectal cancer care. The future of TEMS in the organ preserving treatment of early rectal cancer is discussed and how as clinicians we are able to select the correct patients for neoadjuvant or radical treatments accurately. The role of radiotherapy and outcomes from combination treatment using TEMS are presented with suggestions for areas of future research.
    Best practice & research. Clinical gastroenterology 02/2014; 28(1):143-157. DOI:10.1016/j.bpg.2013.11.005 · 3.28 Impact Factor
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    • "improved precision with margin outline, dissection, and defect closure [4]. The rate of conversion to open surgery is 1% with a complication rate ranging from 4– 28%, significantly lower than the complication rates associated with radical resection which approaches 50% [4] [7] [11] [12] [13] [14] [15]. Prior to the advent of laparoscopic colorectal surgery, the learning curves for using the TEM and transanal endoscopic operation (TEO) rigid operating proctoscopes and equipment were steep and resulted in a slow adoption of the technique in the United States where TAE remains the most common procedure for local resection of rectal tumors [4]. "
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    ABSTRACT: Background: Transanal endoscopic surgical (TES) resection using rigid transanal platforms (TEM, TEO) is associated with improved outcomes compared to traditional transanal excision (TAE) of rectal lesions. An alternative technique using a disposable single incision surgery platform was developed in 2009, transanal minimally invasive surgery (TAMIS), resulting in a surge in interest and access to transanal access platforms to perform TES. However, compared to rigid transanal access platforms, the disposable platforms do not facilitate internal rectal retraction and have limited proximal reach. A new long channel disposable transanal access platform has been developed (15 cm in length, 4 cm in width) thereby facilitating endoluminal surgical access to the upper rectum and rectosigmoid colon. Methods: This is a retrospective case series report. Patient demographics and peri-operative outcome variables were recorded. The Gelpoint Path Long Channel was utilized in three patients with proximal rectal lesions that were not accessible using a standard disposable transanal access platform. Results: Three patients underwent TES excision of rectal adenomas using a long channel, disposable, transanal access platform. All patients were female, aged 51 – 53, BMI 23-32 kg/m 2 . The tumor size ranged from 2.4 – 8.5 cm, 15-100% circumference, and proximal location from the dentate line ranged from 9 – 11 cm. Final pathology revealed adenoma with negative margins in all three cases. The hospital length of stay ranged from 1 – 3 days and there were no peri-operative complications. None of the patients have developed a local recurrence during the follow up period ranging from 5 – 11 months. Conclusions: The new long channel, disposable, transanal access platform facilitates transanal endoluminal surgical removal of lesions in the mid to upper rectum that may be difficult to reach using the standard disposable transanal access devices. We have successfully achieved 100% margin negative rate using this new device in this small series of patients with proximal rectal adenomas.
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    • "improved precision with margin outline, dissection, and defect closure [4]. The rate of conversion to open surgery is 1% with a complication rate ranging from 4– 28%, significantly lower than the complication rates associated with radical resection which approaches 50% [4] [7] [11] [12] [13] [14] [15]. Prior to the advent of laparoscopic colorectal surgery, the learning curves for using the TEM and transanal endoscopic operation (TEO) rigid operating proctoscopes and equipment were steep and resulted in a slow adoption of the technique in the United States where TAE remains the most common procedure for local resection of rectal tumors [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Transanal endoscopic surgical (TES) resection using rigid transanal platforms (TEM, TEO) is associated with improved outcomes compared to traditional transanal excision (TAE) of rectal lesions. An alternative technique using a disposable single incision surgery platform was developed in 2009, transanal minimally invasive surgery (TAMIS), resulting in a surge in interest and access to transanal access platforms to perform TES. However, compared to rigid transanal access platforms, the disposable platforms do not facilitate internal rectal retraction and have limited proximal reach. A new long channel disposable transanal access platform has been developed (15 cm in length, 4 cm in width) thereby facilitating endoluminal surgical access to the upper rectum and rectosigmoid colon. Methods: This is a retrospective case series report. Patient demographics and peri-operative outcome variables were recorded. The Gelpoint Path Long Channel was utilized in three patients with proximal rectal lesions that were not accessible using a standard disposable transanal access platform. Results: Three patients underwent TES excision of rectal adenomas using a long channel, disposable, transanal access platform. All patients were female, aged 51 – 53, BMI 23-32 kg/m 2 . The tumor size ranged from 2.4 – 8.5 cm, 15-100% circumference, and proximal location from the dentate line ranged from 9 – 11 cm. Final pathology revealed adenoma with negative margins in all three cases. The hospital length of stay ranged from 1 – 3 days and there were no peri-operative complications. None of the patients have developed a local recurrence during the follow up period ranging from 5 – 11 months. Conclusions: The new long channel, disposable, transanal access platform facilitates transanal endoluminal surgical removal of lesions in the mid to upper rectum that may be difficult to reach using the standard disposable transanal access devices. We have successfully achieved 100% margin negative rate using this new device in this small series of patients with proximal rectal adenomas.
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