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Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM)

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Transanal endoscopic microsurgery (TEM) is a consolidated technique for the excision of rectal tumors. However, many aspects relating to its morbidity, risk of functional alterations, and therapeutic outcomes are still unclear. The aim of this study was to assess the rate of morbidity and fecal incontinence after TEM, and to identify associated risk factors.

Methods

We prospectively recorded the clinical data of 157 patients who underwent TEM from 1996 to 2013. Among these, 89 patients answered a questionnaire for the assessment of fecal continence at a median follow-up time of 40 months.

Results

Intraoperative and postoperative TEM complication rates were 3.8 and 20.4 %. The mortality rate was 0.6 %. A distance from the anal verge of more than 6 cm correlated with a higher risk of perforation, while patients with cancer were more likely to have postoperative bleeding. Incontinence was reported by 32 (36 %) patients, of which 7 (8 %) experienced transitory symptoms only, while 25 (28 %) reported persistent symptoms. We found a correlation between patients receiving preoperative radiotherapy (RT) and the development of fecal incontinence. The recurrence rate was 3 % (1/32) in pT1, 80 % (4/5) in pT2, and 100 % (1/1) in pT3. After radiotherapy, 7 % (1/9) showed a good response (pT0-1), and 18 % (2/7) showed no response (pT2-3).

Conclusions

TEM is associated with low morbidity but the risk of developing functional alterations is not negligible and should be discussed with the patient before the operation. Good oncological outcomes are possible for early invasive cancers and for selected advanced cancers following a good response to preoperative RT.

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Acknowledgments

The authors gratefully acknowledges Sardinia Regional Government for the financial support (P.O.R. Sardegna F.S.E. Operational Programme of the Autonomous Region of Sardinia, European Social Fund 2007–2013 - Axis IV Human Resources, Objective l.3, Line of Activity l.3.1 “Avviso di chiamata per il finanziamento di Assegni di Ricerca”

Financial disclosure

Angelo Restivo receives financial support for his activity from Regional government.

Conflict of interest

The authors declare that they have no competing interests.

Authors’ contribution

Angelo Restivo, MD, Assistant Professor of Surgery, contributed to the design, acquisition of data, analysis and interpretation of data, drafting of the article, and final approval of the version to be published. Luigi Zorcolo, MD, Assistant Professor of Surgery, contributed to the analysis and interpretation of data, revision of the manuscript, and final approval of the version to be published. Giuseppe D’Alia, MD, contributed to the acquisition of data, revision of the manuscript, and final approval of the version to be published. Francesca Cocco, MD, Research Assistant, contributed to the acquisition of data, revision of the manuscript, and final approval of the version to be published. Andrea Cossu, MD, Surgical Resident, contributed to the acquisition of data, revision of the manuscript, and final approval of the version to be published. Francesco Scintu, MDProf, Associate Professor of Surgery, contributed to the acquisition of data, revision of the manuscript, and final approval of the version to be published. Giuseppe Casula, Prof., Professor of Surgery, Chief of Department, contributed to the acquisition of data, revision of the manuscript, and final approval of the version to be published.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

    Angelo Restivo, Luigi Zorcolo, Francesca Cocco, Andrea Cossu, Francesco Scintu & Giuseppe Casula

  2. Chirurgia Generale M - Colorectal Center, Digestive Surgical Endoscopy section, AOU Cagliari, Cagliari, Italy

    Giuseppe D’Alia

  3. Chirurgia Generale M - Colorectal Center, AOU Cagliari, Cagliari, Italy

    Angelo Restivo, Luigi Zorcolo & Francesco Scintu

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  1. Angelo Restivo
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Correspondence to Angelo Restivo.

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Restivo, A., Zorcolo, L., D’Alia, G. et al. Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM). Int J Colorectal Dis 31, 257–266 (2016). https://doi.org/10.1007/s00384-015-2371-y

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