Advertisement

Endoscopic and Transanal Approaches for Acute Anal and Rectal Cancers

  • John McClellan
  • Anjali S. Kumar
Chapter

Abstract

In the management of early-stage rectal cancer, several techniques can be considered for local excision: total mesorectal excision (TME), transanal endoscopic microsurgery (TEM), transanal minimally invasive surgery (TAMIS), endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD), and robotic surgical approaches. Endoscopic and transanal approaches allow patients to avoid the morbidity of radical surgery (proctectomy with total mesorectal excision). This article provides an overview of these local excision techniques and reviews the indications for their use. While it is important for the acute care surgeon to know of these modalities, expertise may be held by an advanced gastroenterologist or a colorectal surgeon, so consultation of these specialists can be thoughtfully considered.

Keywords

Colorectal surgery Anorectal malignancies Transanal excision Endoscopy Minimally invasive surgery Anorectal bleeding Rectal obstruction 

References

  1. 1.
    Morson BC, Bussey HJ, Samoorian S. Policy of local excision for early cancer of the colorectum. Gut. 1977;18(12):1045–50.CrossRefGoogle Scholar
  2. 2.
    McCall JL, Cox MR, Wattchow DA. Analysis of local recurrence rates after surgery alone for rectal cancer. Int J Color Dis. 1995;10(3):126–32.CrossRefGoogle Scholar
  3. 3.
    Enriquez-Navascues JM, Borda N, Lizerazu A, et al. Patterns of local recurrence in rectal cancer after a multidisciplinary approach. World J Gastroenterol. 2011;17(13):1674–84.CrossRefGoogle Scholar
  4. 4.
    You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg. 2007;245(5):726–33.CrossRefGoogle Scholar
  5. 5.
    Brunner W, Widmann B, Marti L, Tarantino I, Schmied BM, Warschkow R. Predictors for regional lymph node metastasis in T1 rectal cancer: a population-based SEER analysis. Surg Endosc. 2016;30(10):4405–15.CrossRefGoogle Scholar
  6. 6.
    Nicholls RJ, Galloway DJ, Mason AY, Boyle P. Clinical local staging of rectal cancer. Br J Surg. 1985;72(Suppl):S51–2.CrossRefGoogle Scholar
  7. 7.
    Blumberg D, Paty PB, Guillem JG, et al. All patients with small intramural rectal cancers are at risk for lymph node metastasis. Dis Colon Rectum. 1999;42(7):881–5.CrossRefGoogle Scholar
  8. 8.
    Kitajima K, Fujimori T, Fujii S, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol. 2004;39(6):534–43.CrossRefGoogle Scholar
  9. 9.
    Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002;45(2):200–6.CrossRefGoogle Scholar
  10. 10.
    Landmann RG, Wong WD, Hoepfl J, et al. Limitations of early rectal cancer nodal staging may explain failure after local excision. Dis Colon Rectum. 2007;50(10):1520–5.CrossRefGoogle Scholar
  11. 11.
    Kennedy E, Vella ET, Blair Macdonald D, Wong CS, McLeod R, Cancer Care Ontario Preoperative Assessment for Rectal Cancer Guideline Development G. Optimisation of preoperative assessment in patients diagnosed with rectal cancer. Clin Oncol (R Coll Radiol). 2015;27(4):225–45.CrossRefGoogle Scholar
  12. 12.
    Kwok H, Bissett IP, Hill GL. Preoperative staging of rectal cancer. Int J Color Dis. 2000;15(1):9–20.CrossRefGoogle Scholar
  13. 13.
    De Ceglie A, Hassan C, Mangiavillano B, et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol. 2016;104:138–55.CrossRefGoogle Scholar
  14. 14.
    Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417–34.CrossRefGoogle Scholar
  15. 15.
    Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2015;47(9):829–54.CrossRefGoogle Scholar
  16. 16.
    Marks J, Ng S, Mak T. Robotic transanal surgery (RTAS) with utilization of a next-generation single-port system: a cadaveric feasibility study. Tech Coloproctol. 2017;21(7):541–5.CrossRefGoogle Scholar
  17. 17.
    Kwan V, Bourke MJ, Williams SJ, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol. 2006;101:58–63.CrossRefGoogle Scholar
  18. 18.
    Olmos JA, Marcolongo M, Pogorelsky V, et al. Long-term outcome of argon plasma ablation therapy for bleeding in 100 consecutive patients with colonic angiodysplasia. Dis Colon Rectum. 2006;49:1507–16.CrossRefGoogle Scholar
  19. 19.
    Harris GJ, Senagore AJ, Lavery IC, Fazio VW. The management of neoplastic colorectal obstruction with colonic endolumenal stenting devices. Am J Surg. 2001;181(6):499–506.CrossRefGoogle Scholar
  20. 20.
    Lee HJ, Hong SP, Cheon JH, Kim TI, Kim WH, Park SJ. Clinical Outcomes of self-expandable metal stents for malignant rectal obstruction. Dis Colon Rectum. 2018;61(1):43–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • John McClellan
    • 1
  • Anjali S. Kumar
    • 2
  1. 1.Madigan Army Medical CenterTacomaUSA
  2. 2.Elson Clinical Education, Surgery, Elson S. Floyd College of MedicineWashington State UniversityEverett/Spokane/Tri-Cities/VancouverUSA

Personalised recommendations