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Serra-Aracil X, Gil-Barrionuevo E, Lobato-Gil R, Gonzalez-Costa A, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Navarro-Soto S. Is obesity a factor of surgical difficulty in transanal endoscopic surgery? Am J Surg 2020; 220:687-692. [PMID: 31983409 DOI: 10.1016/j.amjsurg.2020.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients. METHODS Observational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) < 30 kg/m2 and BMI ≥30 kg/m2, the latter defined as obese. RESULTS From 775 patients, 681 were enrolled in the study, 145 (21.3%) of them obese. No statistically significant differences between groups were found with respect to overall morbidity (27, 18.6%).The obese patients presented trends towards shorter mean surgical time (65 min, IQR 48 min), less perforation in the peritoneal cavity (eight, 5.5%), and 133 (91.7%) presented a lower rate of lesion fragmentation. CONCLUSION There were no significant differences in postoperative outcomes in obese patients (BMI ≥30 kg/m2). TES in those obese patients does not represent a factor of surgical difficulty.
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Affiliation(s)
- Xavier Serra-Aracil
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain.
| | - Esther Gil-Barrionuevo
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Raquel Lobato-Gil
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Anna Gonzalez-Costa
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Laura Mora-López
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Anna Pallisera-Lloveras
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Sheila Serra-Pla
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
| | - Salvador Navarro-Soto
- Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain
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Serra-Aracil X, Ruiz-Edo N, Casalots-Casado A, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Puig-Diví V, Navarro-Soto S. Importance of Resection Margins in the Treatment of Rectal Adenomas by Transanal Endoscopic Surgery. J Gastrointest Surg 2019. [PMID: 30306452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Polypectomy is the gold standard for treating colorectal adenomas up to 2 cm in size. For larger lesions, various procedures ranging from endoscopy to transanal surgery can be performed and achieve varying results for en bloc resection and recurrence. There are no clear guidelines for dealing with involved resection margins. We assess the recurrence of rectal adenomas operated using TEM with full-thickness wall excision with or without free resection margins and define optimal endoscopic follow-up. METHOD Observational study with prospective data collection, including patients undergoing TEM between 6/2004 and 11/2017, with definitive diagnosis of rectal adenoma. Data on epidemiological, preoperative, surgical, postoperative, pathological, and follow-up variables were recorded. Univariate analysis, follow-up risk function, and multivariate logistic regression analysis were performed to detect risk factors for recurrence. RESULTS TEM was indicated in 736 patients; 481 adenomas were identified in the preoperative biopsy, of which 95 were infiltrating adenocarcinomas (19.8%) in the definitive pathology study. With a minimum follow-up of 1 year, 372 patients were included. Pathology study showed free margins in 324 (87%). Recurrences were recorded in 15 patients (4%), up to 18 months in the free margins group and up to 24 months in the involved margins group. Thirteen patients with recurrence (86.6%) were treated with TEM. No predictors of recurrence were found in the multivariate analysis. CONCLUSION TEM is the technique of choice for treating rectal adenomas and recurrences, achieving a low relapse rate. Follow-up must be adapted to resection margins and should be extended to 24 months.
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Affiliation(s)
- Xavier Serra-Aracil
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Neus Ruiz-Edo
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain.
| | - Alex Casalots-Casado
- Department of Pathology, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Laura Mora-López
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Anna Pallisera-Lloveras
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Sheila Serra-Pla
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Vanlentí Puig-Diví
- Department of Gastrointestinal Endoscopy, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
| | - Salvador Navarro-Soto
- Department of General and Digestive Surgery, Department of Colorectal Surgery, Parc Taulí University Hospital, Sabadell, Universitat Autònoma de Barcelona (UAB), Parc Taulí Street s/n, 08208, Sabadell, Barcelona, Spain
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Serra-Aracil X, Ruiz-Edo N, Casalots-Casado A, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Puig-Diví V, Navarro-Soto S. Importance of Resection Margins in the Treatment of Rectal Adenomas by Transanal Endoscopic Surgery. J Gastrointest Surg 2019; 23:1874-83. [PMID: 30306452 DOI: 10.1007/s11605-018-3980-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polypectomy is the gold standard for treating colorectal adenomas up to 2 cm in size. For larger lesions, various procedures ranging from endoscopy to transanal surgery can be performed and achieve varying results for en bloc resection and recurrence. There are no clear guidelines for dealing with involved resection margins. We assess the recurrence of rectal adenomas operated using TEM with full-thickness wall excision with or without free resection margins and define optimal endoscopic follow-up. METHOD Observational study with prospective data collection, including patients undergoing TEM between 6/2004 and 11/2017, with definitive diagnosis of rectal adenoma. Data on epidemiological, preoperative, surgical, postoperative, pathological, and follow-up variables were recorded. Univariate analysis, follow-up risk function, and multivariate logistic regression analysis were performed to detect risk factors for recurrence. RESULTS TEM was indicated in 736 patients; 481 adenomas were identified in the preoperative biopsy, of which 95 were infiltrating adenocarcinomas (19.8%) in the definitive pathology study. With a minimum follow-up of 1 year, 372 patients were included. Pathology study showed free margins in 324 (87%). Recurrences were recorded in 15 patients (4%), up to 18 months in the free margins group and up to 24 months in the involved margins group. Thirteen patients with recurrence (86.6%) were treated with TEM. No predictors of recurrence were found in the multivariate analysis. CONCLUSION TEM is the technique of choice for treating rectal adenomas and recurrences, achieving a low relapse rate. Follow-up must be adapted to resection margins and should be extended to 24 months.
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Gavilanes Calvo C, Manuel Palazuelos JC, Alonso Martín J, Castillo Diego J, Martín Parra I, Gómez Ruiz M, Gómez Fleitas M. [Transanal endoscopic operations for rectal tumours]. Cir Esp 2013; 92:38-43. [PMID: 24169437 DOI: 10.1016/j.ciresp.2013.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transanal endoscopic operation (TEO) may be the technique of choice for the treatment of rectal lesions, both benign and selected malignant lesions, with similar survival rates to conventional surgery but with lower morbidity. METHODS In this article we present a series of 70 patients operated on with this procedure (TEO) in our center. The indications were benign rectal lesions and malignant lesions at early stages (T1) 86%. The surgical procedure was performed with the the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) and ultrasonic scalpel (Harmonic scalpel, Ethicon Endo-surgery,…). RESULTS The indication in 43 patients was a benign lesion (adenoma), in the other 27 the diagnosis was adenocarcinoma. After the resection, 61% of the series had a malignant lesion in the pathology report: 13 patients of the 43 with a benign lesion initially had a malignant lesion in the pathology report. Postoperative morbidity was 36%, Clavien III (5,7%). 3 patients (4%) needed emergency surgery. All of the benign lesions were completely excised, but 7 malignant lesions had resection margin involvement The median follow-up time was 26,4 months (range, 1-71 months), the overall recurrence for benign tumors was 9%, 8% for malignant pT1 and 12,5% for malignant pT2. Early salvage surgery was performed on 8 patients. CONCLUSIONS TEO allows us to excise benign rectal lesions that could not be excised with a conventional approach (endoscopic or transanal resection) with a low morbidity rate. TEO can be used for malignant rectal tumors in early stages (pT1) with pathological confirmation.
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Affiliation(s)
- Carlos Gavilanes Calvo
- Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - Joaquín Alonso Martín
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Ignacio Martín Parra
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Marcos Gómez Ruiz
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Unidad Colorrectal, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, España; Cátedra de Cirugía General, Universidad de Cantabria, Santander, España
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