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Surgical Endoscopy

, Volume 33, Issue 1, pp 184–191 | Cite as

Transanal endoscopic micro-surgery in elderly and very elderly patients: a safe option? Observational study with prospective data collection

  • X. Serra-Aracil
  • S. Serra-PlaEmail author
  • L. Mora-Lopez
  • A. Pallisera-Lloveras
  • M. Labro-Ciurans
  • S. Navarro-Soto
Article

Abstract

Background

Although the incidence of colorectal cancer increases with the patient’s age, the elderly continue to be less likely to be scheduled for surgery. Transanal endoscopic micro-surgery (TEM) is a surgical alternative to total mesorectal excision (TME) in early stage rectal cancer and/or in selected patients that could decrease morbidity and mortality rates in this group of patients. Our main objective is to assess the safety and feasibility of TEM in elderly (75–84 years) and very elderly (≥ 85 years) patients.

Methods

Observational study was conducted with prospective data collection of all consecutive patients who underwent TEM between April 2004 and January 2017. Patients were assigned to groups according to age. Descriptive and comparative analyses between groups were performed.

Results

We analyzed 693 patients, 429 patients < 75 years (61.9%), 220 patients between the ages of 75 and 84 (31.7%), and 44 patients ≥ 85 years old (6.3%). The tendency in our series is to increase comorbidities with age. Palliative or consensus intent was more frequently performed in elderly (10.5%, 34/220), and very elderly (45.4%, 20/44), compared with the youngest (6.3%, 27/429), (p < 0.001). Global morbidity presented an increasing trend related to age from 20.3% in < 75 years, to 25.9% in elderly and 34.1% in very elderly. Surgical complications were recorded in 18.5% (128/693) of patients with no significant differences between groups. The most common one was rectal bleeding 16.1% (111/693). Significant differences were found in non-surgical complications, recorded in 7.3% (16/220) in the elderly, and 15.9% (7/44) in the group above 84 years (p = 0.013).

Conclusions

TEM presents acceptable morbidity rates mainly due to non-surgical-related adverse effects in elderly and very elderly patients and may be a feasible and safe alternative in this population in both curative and non-curative indications.

Keywords

Transanal endoscopic micro-surgery Elderly Rectal cancer Transanal endoscopic operation Minimally invasive surgery 

Notes

Compliance with ethical standards

Disclosures

Drs. Serra-Aracil, Serra-Pla, Mora, Pallisera, Labro, and Navarro have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Simmonds PD, Best L, George S, Baughan C, Buchanan R, Davis C et al (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356(9234):968–974CrossRefGoogle Scholar
  2. 2.
    Hosking MP1, Warner MA, Lobdell CM, Offord KPML (1989) Outcomes of surgery in patients 90 years of age and older. JAMA 261(13):1909–1915CrossRefPubMedGoogle Scholar
  3. 3.
    Nakamura T, Sato T, Miura H, Ikeda A, Tsutsui A, Naito M et al (2014) Feasibility and outcomes of surgical therapy in very elderly patients with colorectal cancer. Surg Laparosc Endosc Percutan Tech 24(1):85–88CrossRefPubMedGoogle Scholar
  4. 4.
    Newcomb P, Carbone P (1993) Cancer treatment and age: patient perspectives. J Natl Cancer Inst 85(19):1580–1584CrossRefPubMedGoogle Scholar
  5. 5.
    Vermillion S, Hsu F, Dorrell R, Shen P, Clark C (2017) Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol 115(8):997–1003CrossRefPubMedGoogle Scholar
  6. 6.
    Serra-Aracil X, Mora-López L (2016) Hybrid NOTES: TEO for transanal total mesorectal excision : intracorporeal resection and anastomosis. Surg Endosc 30:346–354CrossRefPubMedGoogle Scholar
  7. 7.
    Serra Aracil X, Junca -Bombardó J, López LM, Moral MA, Garnica IA, Soto SN (2006) Transanal endoscopic microsurgery (TEM). Current situation and future expectations [Microcirugía endoscópica transanal (TEM). Situación actual y expectativas de futuro]. Cir Esp 80(3):123–132CrossRefPubMedGoogle Scholar
  8. 8.
    Allaix M, Arezzo A, Caldart M, Festa F, Morino M (2009) Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 52:1831–1836CrossRefPubMedGoogle Scholar
  9. 9.
    Laliberte A, Lebrun A, Drolet S, Bouchard P, Bouchard A (2015) Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe. Surg Endosc 29(12):3454–3459CrossRefPubMedGoogle Scholar
  10. 10.
    López LM, Serra-aracil X, Soto SN, López LM, Serra-aracil X, Soto SN (2015) Sphincter lesions observed on ultrasound after transanal endoscopic surgery. World J Gastroenterol 21(46):13160–13165CrossRefGoogle Scholar
  11. 11.
    Lee W, Lee D, Chois S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17(8):1283–1287CrossRefPubMedGoogle Scholar
  12. 12.
    Buess G, Hutterer F, Theiss J (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680PubMedGoogle Scholar
  13. 13.
    Rocha JJ, Feres O (2008) Transanal endoscopic operation: a new proposal. Acta Cir Bras 23(Supl 1):93–104CrossRefPubMedGoogle Scholar
  14. 14.
    Barendse R, Dijkgraaf M, Rolf U, Bijnen A, Consten E, Hoff C et al (2013) Colorectal surgeons’learning curve of transanal endoscopic microsurgery. Surg Endosc 27(10):3591–3602CrossRefPubMedGoogle Scholar
  15. 15.
    Maya A, Vorenberg A, Oviedo M, da Silva G, Wexner S, Sands D (2014) Learning curve for transanal endoscopic microsurgery: a single-center experience. Surg Endosc 28(5):1407–1412CrossRefPubMedGoogle Scholar
  16. 16.
    Serra-Aracil X, Vallverdú H, Bombardó-Junca J, Pericay C, Urgellés-Bosch J, Navarro-Soto S (2008) Long-term follow-up of local rectal cancer surgery by transanal endoscopic microsurgery. World J Surg 32(6):1162–1167CrossRefPubMedGoogle Scholar
  17. 17.
    Serra X, Bombardo J, Mora L, Alcantara M, Ayguavives I, Darnell A et al (2009) Lugar de la cirugía local en el adenocarcinoma de recto T2N0M0. Cir Esp 85(2):103–109CrossRefGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien P (2004) Classification of surgical complications. Ann Surg 240(2):205–213CrossRefPubMedGoogle Scholar
  19. 19.
    Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ, Navarro-Soto S (2014) Transanal endoscopic surgery in rectal cancer. World J Gastroenterol 20(33):11538–11545CrossRefPubMedGoogle Scholar
  20. 20.
    Althumairi AA, Gearhart SL (2015) Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol 6(3):296–306PubMedGoogle Scholar
  21. 21.
    Serra-Aracil X, Caro-Tarrago A, Mora-López L, Casalots A, Rebasa P, Navarro-Soto S (2014) Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum 57(7):823–829CrossRefPubMedGoogle Scholar
  22. 22.
    Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Navarro-Soto S (2014) Transanal endoscopic microsurgery with 3-D (TEM) or high-definition 2-D transanal endoscopic operation (TEO) for rectal tumors. A prospective, randomized clinical trial. Int J Color Dis 29:605–610CrossRefGoogle Scholar
  23. 23.
    Brown C, Raval M, Phang P, Karimuddin A (2017) The surgical defect after transanal endoscopic microsurgery: open versus closed management. Surg Endosc 31(3):1078–1082CrossRefPubMedGoogle Scholar
  24. 24.
    Rebasa P, Mora L, Vallverdú H, Luna A, Montmany S, Romaguera A et al (2011) Efectos adversos en cirugía general. Análisis prospectivo de 13.950 pacientes consecutivos. Cir Esp 89(9):599–605CrossRefPubMedGoogle Scholar
  25. 25.
    Lee L, Burke J, DeBeche-Adams T, Nassif G, Martin-Perez B, Monson J et al (2017) Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg 267:910–916CrossRefGoogle Scholar
  26. 26.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Ser A 59:255–263CrossRefGoogle Scholar
  27. 27.
    Mogal H, Vermilion SA, Dodson R, Hsu F-C, Howerton R, Shen P et al (2017) Modified frailty index predicts morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol 24:1714–1721CrossRefPubMedGoogle Scholar
  28. 28.
    Ronning B, Bruun Wyller T, Nedbakken A, Skovlund E, Slaaen Jordhoy M, Bakka A et al (2016) Quality of life in older and frail patients after surgery for colorectal cancer—a follow-up study. J Geriatr Oncol 7:195–200CrossRefPubMedGoogle Scholar
  29. 29.
    Amblàs-Novellas J, Martori JC, Molins Brunet N, Oller R, Gómez-Batiste X, Espaluella Panicot J (2017) Índice frágil-VIG: diseño y evaluación de un índice de fragilidad basado en la Valoración Integral Geriátrica. Rev Esp Geriatr Gerontol 5(3):119–127CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University HospitalUniversitat Autònoma de BarcelonaSabadellSpain
  2. 2.General and Digestive Surgery Department, Parc Tauli University HospitalUniversitat Autònoma de BarcelonaSabadellSpain

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