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Transanal endoscopic microsurgery for upper rectal tumors

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Abstract

Background

Compared with traditional rectal resection, transanal endoscopic microsurgery (TEM) is faster and safer. This retrospective study sought to assess the efficacy of TEM for lesions located in the upper rectum, ≥10 cm from the anal verge.

Methods

Data from all patients who underwent TEM for rectal lesions ≥10 cm from the anal verge between 2001 and 2010 at two medical centers in Israel were retrospectively analyzed. The study group comprised 96 patients (57 men, 39 women) who underwent 99 TEM procedures. Collected data included patient demographics, tumor characteristics, indications for surgery, operative findings and details, postoperative outcomes, and histopathologic findings. Long-term outcomes including local recurrence (LR) for benign lesions and LR and overall survival (OS) for malignant lesions were calculated. Categorical variables were calculated by frequency tables, and linear variables were represented by averages and standard deviation or median with the spread of variables. Survival and LR analysis was performed by Kaplan–Meier and Cox regression methods.

Results

The mean tumor distance from the  anal verge was  11.3 ± 2 cm and the median tumor size was 2 cm. Early postoperative outcomes were favorable, and no early postoperative mortality was reported. The postoperative morbidity rate was 10 %. For long-term outcomes, in the subgroup with benign lesions, after a median follow-up of 8.7 years, the LR rate was 5.1 %. In the group with malignant lesions, LR and OS rates were 6.9 and 87 %, respectively.

Conclusions

TEM for upper rectal lesions is feasible and may be safe in selected cases. Low morbidity rate, shorter operative time and length of stay, no mortality events, and favorable long-term outcomes support the use of TEM for the treatment of lesions in the upper rectum.

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Disclosures

Drs. Khoury, Igov, Issa, and Duek, and Mr. Gimelfarb have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Surgery, Rambam Health Care Campus, 8th Ha’alia St, Haifa, Israel

    Wisam Khoury & Simon D. Duek

  2. Department of General Surgery, Laniado Medical Center, Netanya, Israel

    Igor Igov

  3. Department of General Surgery, Hasharon Medical Center, Petah Tikva, Israel

    Nidal Issa

  4. AHMC Tel-Aviv, Tel-Aviv, Israel

    Yuri Gimelfarb

Authors
  1. Wisam Khoury
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  2. Igor Igov
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  3. Nidal Issa
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  4. Yuri Gimelfarb
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  5. Simon D. Duek
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Corresponding author

Correspondence to Wisam Khoury.

Additional information

Wisam Khoury and Igov Igov contributed equally to this article, and both should be considered first author.

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Khoury, W., Igov, I., Issa, N. et al. Transanal endoscopic microsurgery for upper rectal tumors. Surg Endosc 28, 2066–2071 (2014). https://doi.org/10.1007/s00464-014-3428-7

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  • DOI: https://doi.org/10.1007/s00464-014-3428-7

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