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Transanal Endoscopic Microsurgery for Rectal Neoplasms. How I Do It

  • How I do it
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcomes of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas, and may represent a possible treatment modality for early rectal cancer.

Methods

A full-thickness excision is made on the rectal wall down to the perirectal fatty tissue. The specimen is retrieved transanally. After the parietal defect is disinfected, the wound is closed with one or more running sutures secured with silver clips.

Results

Peritoneal perforation during TEM is not associated with adverse short-term or oncologic outcomes. The postoperative morbidity rate ranges between 2 % and 15 %, and in most cases, complications can be conservatively managed. The local recurrence rate of large adenomas is about 6 %, and most recurrences can be safely re-resected by TEM. TEM represents an effective treatment for pT1 sm1 rectal malignancies, while pT1 sm2-3 and pT2 should be considered at high risk of recurrence if treated by TEM alone. Finally, TEM does not influence anorectal function or quality of life.

Conclusion

TEM is a safe procedure and provides excellent functional and oncologic outcomes in the treatment of large sessile benign rectal lesions and selected early rectal cancers.

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References

  1. MacFarlane JK, Ryall RDH, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993; 341: 457–460.

    Article  PubMed  CAS  Google Scholar 

  2. Heald RJ, Moran BJ, Ryall RDH, Sexton R, MacFarlane JK. The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998; 133: 894–899.

    Article  PubMed  CAS  Google Scholar 

  3. Morris E, Quirke P, Thomas JD, Fairley L, Cottier B, Forman D. Unacceptable variation in abdominoperineal excision rates for rectal cancer: time to intervene? Gut 2008; 57: 1690–1697.

    Article  PubMed  CAS  Google Scholar 

  4. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008;248: 52–60.

    Article  PubMed  Google Scholar 

  5. Hoerske C, Weber K, Goehl J, Hohenberger W, Merkel S. Long-term outcomes and quality of life after rectal carcinoma surgery. Br J Surg 2010; 97: 1295–1303

    Article  PubMed  CAS  Google Scholar 

  6. Morino M, Parini U, Allaix ME, Monasterolo G, Brachet Contul R, Garrone C. Male sexual and urinary function after laparoscopic total mesorectal excision. Surg Endosc 2009; 23: 1233–240.

    Article  PubMed  Google Scholar 

  7. Marijnen CAM, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, Kranenbarg EK, Leer JW; Cooperative Investigators of the Dutch Colorectal Cancer Group. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002; 20: 817–825

    Article  PubMed  CAS  Google Scholar 

  8. Wallner C, Lange MM, Bonsing BA, Maas CP,Wallace CN, Dabhoiwala NF, Rutten HJ, Lamers WH, Deruiter MC, van de Velde CJ; Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial. Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial. J Clin Oncol 2008; 26: 4466–4472

    Article  PubMed  Google Scholar 

  9. Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, Macrae HM, Gryfe R, McLeod RS. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005; 242: 212–223.

    Article  PubMed  Google Scholar 

  10. Ho P, Law WL, Chan SC, Lam CK, Chu KW. Functional outcome following low anterior resection with total mesorectal excision in the elderly. Int J Colorectal Dis 2003; 18: 230–233.

    PubMed  Google Scholar 

  11. Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H. A system for a transanal endoscopic rectum operation. Chirurg 1984; 55:677–680.

    PubMed  CAS  Google Scholar 

  12. Sakamoto GD, MacKeigan JM, Senagore AJ. Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 1991;34:880–885.

    Article  PubMed  CAS  Google Scholar 

  13. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, García-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 2000;43:1064–1074.

    Article  PubMed  CAS  Google Scholar 

  14. de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis 2011;13:762-767.

    Article  PubMed  Google Scholar 

  15. Casadesus D. Surgical resection of rectal adenoma: a rapid review. World J Gastroenterol 2009;15:3851-3844.

    Article  PubMed  Google Scholar 

  16. Suppiah A, Maslekar S, Alabi A, Hartley JE, Monson JR. Transanal endoscopic microsurgery in early rectal cancer: time for a trial? Colorectal Dis 2008;10:314-327

    Article  PubMed  CAS  Google Scholar 

  17. Wu Y, Wu YY, Li S, Zhu BS, Zhao K, Yang XD, Xing CG. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepatogastroenterology 2011;58:364-368.

    PubMed  Google Scholar 

  18. Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G. Long-term results in patients with T2-3N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 2005;92:1546-1552.

    Article  PubMed  CAS  Google Scholar 

  19. Duek SD, Issa N, Hershko DD, Krausz MM. Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum 2008;51:379-384.

    Article  PubMed  Google Scholar 

  20. Borschitz T, Wachtlin D, Möhler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol2008;15:712-720.

    Article  PubMed  Google Scholar 

  21. Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A. Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery? Surg Endosc. 2012 Jun 21. [Epub ahead of print]

  22. Allaix ME, Arezzo A, Caldart M, Festa F, Morino M. Transanal endoscopic microsurgery for rectal neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 2009;52:1831-1836.

    Article  PubMed  Google Scholar 

  23. Allaix ME, Arezzo A, Cassoni P, Famiglietti F, Morino M. Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc 2012;26:2594-2600.

    Article  PubMed  Google Scholar 

  24. Morino M, Allaix ME, Caldart M, Scozzari G, Arezzo A. Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm. Surg Endosc 2011;25:3683-3690.

    Article  PubMed  Google Scholar 

  25. Allaix ME, Rebecchi F, Giaccone C, Mistrangelo M, Morino M. Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 2011;98:1635-1643.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti 14, 10126, Torino, Italy

    Marco E. Allaix, Alberto Arezzo, Simone Arolfo, Mario Caldart, Fabrizio Rebecchi & Mario Morino

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  1. Marco E. Allaix
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  2. Alberto Arezzo
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  3. Simone Arolfo
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  4. Mario Caldart
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  5. Fabrizio Rebecchi
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  6. Mario Morino
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Correspondence to Mario Morino.

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Allaix, M.E., Arezzo, A., Arolfo, S. et al. Transanal Endoscopic Microsurgery for Rectal Neoplasms. How I Do It. J Gastrointest Surg 17, 586–592 (2013). https://doi.org/10.1007/s11605-012-2060-x

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  • DOI: https://doi.org/10.1007/s11605-012-2060-x

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