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World Journal of Surgery

, Volume 34, Issue 7, pp 1604–1608 | Cite as

Functional and Clinical Results of Transanal Endoscopic Microsurgery Combined with Endoscopic Posterior Mesorectum Resection for the Treatment of Patients with T1 Rectal Cancer

  • Piotr Walega
  • Jakub Kenig
  • Piotr Richter
  • Wojciech Nowak
Article

Abstract

Background

Rectum-sparing transanal endoscopic microsurgery (TEM) is a well-established treatment for T1 carcinomas of the rectum. However, it is associated with an increased rate of local recurrence compared with extended resection. In most cases, this failure is linked to the presence of clinically nondetectable metastases in the regional lymph nodes. Endoscopic posterior mesorectal resection (EPMR) makes it possible to remove the relevant lymphatic drainage of the lower third of the rectum in the minimally invasive way, which can help with adequate tumor staging. The study evaluated the influence of combined TEM and EPMR treatment on the anorectal functions of this group of patients.

Methods

Six consecutive patients (3 women and 3 men; mean age, 71.3 years) with T1 cancer of the rectum were operated on using TEM in combination with EPMR as a two-stage procedure between 2007 and 2009.

Results

After a median follow-up of 19 (range, 8–30) months, none of our patients complained of symptoms of incontinence during the postoperative period apart from one woman with gas incontinence, who was diagnosed preoperatively. There was no statistically significant difference in BAP, SAP, HPZL, or in fecal continence control assessed using the Fecal Incontinence Severity Index before and 1, 3, and 6 months after the procedure. We observed one case of intraoperative complication (perforation) and one case of minor postoperative complication (hematoma formation). There was no evidence of locoregional recurrence.

Conclusions

EPMR in combination with TEM seems to be safe, feasible, and with no impact on the basic anorectal functions.

Keywords

Fecal Incontinence Anorectal Function Fecal Incontinence Severity Index Nitroglycerin Ointment Retrorectal Space 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Piotr Walega
    • 1
  • Jakub Kenig
    • 1
  • Piotr Richter
    • 1
  • Wojciech Nowak
    • 1
  1. 1.3rd Department of General SurgeryJagiellonian University School of MedicineKrakowPoland

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