Abstract
Purpose
Transanal endoscopic microsurgery (TEM) is a technique that has found its place in routine practice due to its minimal invasive character and associated low morbidity. The purpose of this study was to assess the influence of anatomical variables of rectal neoplasms as well as surgeon experience on postoperative complications in patients undergoing TEM at a tertiary care center.
Methods
Data from 288 patients undergoing TEM over a 16 year period were entered in a prospective data base. Anatomical data of rectal neoplasms, operative data, and early postoperative outcome were analyzed retrospectively.
Results
Overall surgical complications [OR 7.0 (1.5–45,5); p < 0.01] and bleeding [OR 222 (82 – 14316); p < 0.01] correlated with the localization of the neoplasm on the lateral wall of the rectum. Furthermore there was a trend for more surgical overall complications as well as bleeding in neoplasms with a diameter of >2 cm and neoplasms located >8 cm from the anal verge. Complications did not correlate with the number of TEM procedures performed.
Conclusion
TEM resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding. The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery.
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References
Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum - testing a new method in animal experiments. Leber Magen Darm 13:73–77
Demartines N, von Flüe MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 25(7):870–875
Neary P, Makin GB, White TJ, White E, Hartley J, MacDonald A, Lee PW, Monson JR (2003) Transanal endoscopic microsurgery: a viable operative alternative in selected patients with rectal lesions. Ann Surg Oncol 10(9):1106–1111
Gavagan JA, Whiteford MH, Swanstrom LL (2004) Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 187(5):630–634
Endreseth BH, Wibe A, Svinsas M, Marvik R, Myrvold HE (2005) Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery. Colorectal Dis 7(2):133–137
Guerrieri M, Feliciotti F, Baldarelli M, Zenobi P, De Sanctis A, Lezoche G, Lezoche E (2003) Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years’ experience. Dig Liver Dis 35(12):876–880
Gao JD, Shao YF, Bi JJ, Shi SS, Liang J, Hu YH (2003) Local excision carcinoma in early stage. World J Gastroenterol 9(4):871–873
de Graaf EJ, Doornebosch PG, Stassen LP, Debets JM, Tetteroo GW, Hop WC (2002) Transanal endoscopic microsurgery for rectal cancer. Eur J Cancer 38(7):904–910
Featherstone JM, Grabham JA, Fozard JB (2004) Peranal excision of large, rectal, villous adenomas. Dis Colon Rectum 47(1):86–89
Dafnis G, Pahlman L, Raab Y, Gustafsson UM, Graf W (2004) Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis 6(5):336–342
Koscinski T, Malinger S, Drews M (2003) Local excision of rectal carcinoma not-exceeding the muscularis layer. Colorectal Dis 5(2):159–163
Palma P, Freudenberg S, Samel S, Post S (2004) Transanal endoscopic microsurgery : indications and results after 100 cases. Colorectal Dis 6:350–355
Kennedy ML, Lubowski DZ, King DW (2002) Transanal endoscopic microsurgery excision: is anorectal function compromised? Dis Colon Rectum 45(5):601–604
Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 16(6):370–376
Bertelli L, Lorenzini L, Bertelli E (1996) The arterial vascularization of the large intestine. Anatomical and radiological study. Surg Radiol Anat 8(Suppl 1):A1–6, S1–59
DiDio LJ, Diaz-Franco C, Schemainda R, Bezerra AJ (1986) Morphology of the middle rectal arteries. A study of 30 cadaveric dissections. Surg Radiol Anat 8(4):229–236
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The excellent secretarial assistance of I. Metzger is greatly appreciated.
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Kreissler-Haag, D., Schuld, J., Lindemann, W. et al. Complications after transanal endoscopic microsurgical resection correlate with location of rectal neoplasms. Surg Endosc 22, 612–616 (2008). https://doi.org/10.1007/s00464-007-9721-y
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DOI: https://doi.org/10.1007/s00464-007-9721-y