Skip to main content

Advertisement

SpringerLink
Log in

Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Management of malignant rectal polyps (MRPs) after endoscopic polypectomy (EP) is still debated. It is sometimes difficult to decide whether to simply follow-up (FU) or to treat such a removed lesion. Transanal endoscopic microsurgery (TEM) could have a role both in T staging and in treating MRPs after EP.

Methods

Patients who underwent a full-thickness TEM within 3 months after an EP between January 2008 and October 2012 were retrospectively analyzed. If post-TEM histology showed locally advanced rectal cancer, patients underwent a total mesorectal excision (TME) within 4–6 weeks. Patients without malignant disease or pT1sm1 cancers at post-TEM histology were followed up every 3 months for 2 years with clinical examination, flexible rectal endoscopy, and neoplastic markers monitoring.

Results

A total of 39 patients were included. Post-EP histology was adenocarcinoma in 27/39 cases (69.2 %) and adenoma in 12/39. Mean operative time was 64.2 min; no 30-day mortality occurred; 30-day morbidity was 2.7 % (rectal bleeding in 1/39 cases). Post-TEM histology showed a T2 cancer in 5/39 patients, four with and one without a previous cancer diagnosis, who were further treated by TME (four RARs and one APR) and are disease free with a mean FU of 24.2 months. Post-TEM histology showed adenoma in 10/39 cases and fibrosis in 24/39. These patients are disease free with a mean FU of 13 months.

Conclusions

A full-thickness TEM after EP of MRPs can establish the presence of residual malignant disease and its depth of invasion, precisely defining the indication to TME. In event of benign post-EP histology, TEM must be performed in presence of macroscopic residual disease, in order to obtain an RO resection and finally exclude cancer, while, in absence of macroscopic residual disease, only close FU is required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46:765–781

    Article  CAS  PubMed  Google Scholar 

  2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  3. Partecipants in the Paris Workshop (2003) The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach and colon. Gastrointest Endosc 58:S3–S43

    Article  Google Scholar 

  4. Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD (1985) Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 89:328–336

    CAS  PubMed  Google Scholar 

  5. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer: risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295

    Article  CAS  PubMed  Google Scholar 

  6. Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45:200–206

    Article  PubMed  Google Scholar 

  7. Kudo S, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, Matsuda T, Mori M, Saito H, Shimoda T, Tanaka S, Watanabe H, Sung JJ, Feld AD, Inadomi JM, O’Brien MJ, Lieberman DA, Ransohoff DF, Soetikno RM, Triadafilopoulos G, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Vieth M, Jass JR, Hurlstone PD (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68:S3–S47

    Article  PubMed  Google Scholar 

  8. Barendse RM, van den Broek FJ, Dekker E, Bemelman WA, de Graaf EJ, Fockens P, Reitsma JB (2011) Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy 43:941–949

    Article  CAS  PubMed  Google Scholar 

  9. Saito Y, Otake Y, Sakamoto T, Nakajima T, Yamada M, Haruyama S, So E, Abe S, Matsuda T (2013) Indications for and technical aspects of colorectal endoscopic submucosal dissection. Gut Liver 7:263–269

    Article  PubMed  PubMed Central  Google Scholar 

  10. Morino M, Arezzo A, Allaix ME (2013) Transanal endoscopic microsurgery. Tech Coloproctol 17:S55–S61

    Article  PubMed  Google Scholar 

  11. Marzouk O, Schofield J (2011) Review of histopathological and molecular prognostic features in colorectal cancer. Cancers 3:2767–2810

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, Matsukuma S, Kanai T, Kurihara H, Ozawa K, Yoshimura K, Bekku S (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127:385–394

    Article  PubMed  Google Scholar 

  13. Meining A, von Delius S, Eames TM, Popp B, Seib HJ, Schmitt W (2011) Risk factors for unfavorable outcomes after endoscopic removal of submucosal invasive colorectal tumors. Clin Gastroenterol Hepatol 9:590–594

    Article  PubMed  Google Scholar 

  14. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, Kumamoto T, Ishiguro S, Kato Y, Shimoda T, Iwashita A, Ajioka Y, Watanabe H, Watanabe T, Muto T, Nagasako K (2004) Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 39:534–543

    PubMed  Google Scholar 

  15. Allaix ME, Arezzo A, Arolfo S, Caldart M, Rebecchi F, Morino M (2013) Transanal endoscopic microsurgery for rectal neoplasms. How I do it. J Gastrointest Surg 17:586–592

    Article  PubMed  Google Scholar 

  16. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  17. Association of Coloproctology of Great Britain and Ireland (2007) Guidelines for the management of colorectal cancer, 3rd edn. ACPGBI, London

    Google Scholar 

  18. Gill MD, Rutter MD, Holtham SJ (2013) Management and short-term outcome of malignant colorectal polyps in the north of England. Colorectal Dis 15:169–176

    Article  CAS  PubMed  Google Scholar 

  19. Butte JM, Tang P, Gonen M, Shia J, Schattner M, Nash GM, Temple LK, Weiser MR (2012) Rate of residual disease after complete endoscopic resection of malignant colonic polyp. Dis Colon Rectum 55:122–127

    Article  PubMed  Google Scholar 

  20. Kim KM, Eo SJ, Shim SG, Chang DK, Kim YH, Rhee PL, Kim JJ, Kim JY (2013) Risk factors for residual cancer and lymph node metastasis after noncurative endoscopic resection of early colorectal cancer. Dis Colon Rectum 56:35–42

    Article  PubMed  Google Scholar 

  21. Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S (2005) Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48:429–437

    Article  PubMed  Google Scholar 

  22. Farhat S, Chaussade S, Ponchon T, Coumaros D, Charachon A, Barrioz T, Koch S, Houcke P, Cellier C, Heresbach D, Lepilliez V, Napoleon B, Bauret P, Coron E, Le Rhun M, Bichard P, Vaillant E, Calazel A, Bensoussan E, Bellon S, Mangialavori L, Robin F, Prat F, SFED ESD study group (2011) Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy 43:664–670

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosures

Simone Arolfo, Marco Ettore Allaix, Marco Migliore, Francesca Cravero, Alberto Arezzo and Mario Morino have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy

    Simone Arolfo, Marco Ettore Allaix, Marco Migliore, Francesca Cravero, Alberto Arezzo & Mario Morino

Authors
  1. Simone Arolfo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Ettore Allaix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Migliore
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Cravero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alberto Arezzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mario Morino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Arolfo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arolfo, S., Allaix, M.E., Migliore, M. et al. Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment. Surg Endosc 28, 1136–1140 (2014). https://doi.org/10.1007/s00464-013-3290-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3290-z

Keywords

Search

Navigation