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Hart A, Clifford K, Thompson-Fawcett M. Recurrence after transanal endoscopic microsurgery for benign and malignant rectal tumours: experience of a single New Zealand centre. ANZ J Surg 2024; 94:412-417. [PMID: 37962083 DOI: 10.1111/ans.18780] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An important marker of quality is the local recurrence rate. The primary objective was to determine local recurrence rates for benign and malignant rectal tumours. METHODS We identified index TEM excisions of rectal adenomas and adenocarcinomas in patients age 18 and over at Dunedin Hospital, New Zealand, between 2000 and 2020, from a prospective database. Surveillance data were collected via chart review. The primary outcome was recurrence rate for adenomas and adenocarcinomas. Secondary outcomes included time to recurrence, association of recurrence with recognized risk factors, and adverse event rates. RESULTS We identified 100 patients for analysis. Of 75 benign cases, 11 (14.7%) developed local recurrence, with 63.6% identified within 1 year. Of the 25 malignant cases (19 T1, 5 T2, 1 T3), 9 (36%) developed recurrence, with 77.8% identified within 2 years. Adverse events occurred in 26% of patients, with no reoperations or deaths. CONCLUSION Our adenoma recurrence rate was at the higher end of the reported range of 2.4-16%. Minor complications were common, but not major morbidity. The propensity for rectal tumours to recur commonly and early reinforces the importance of regular standardized endoscopic surveillance.
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Affiliation(s)
- Alexander Hart
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kari Clifford
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Salameh F, Gilshtein H, Abramov R, Ashkenazi I, Duek D. Transanal endoscopic microsurgery technique: an acceptable approach for retrorectal tumors. Tech Coloproctol 2023; 27:673-678. [PMID: 36645584 DOI: 10.1007/s10151-023-02753-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Retrorectal lesions (RRLs) are rare lesions that originate from the tissue present in the retrorectal space. The gold standard of care is complete resection regardless of pathology. The traditional approaches (anterior, posterior, and combined) are relatively well described. Transanal Endoscopic Microsurgery (TEM) is a minimally invasive technique offered as an alternative approach for RRLs. AIM To evaluate the outcomes of patients diagnosed with RRL and treated by the TEM approach, especially postoperative complications, and the recurrence rate. METHODS Patients with RRLs treated with the TEM technique in one medical center between 2000 and 2020 were identified. Their postoperative outcomes were compared with historical controls. RESULTS Thirty-nine patients diagnosed with RRL were operated on using the TEM platform. Thirty-seven RRLs were benign, and two were malignant. Their median size (IQR) was 20 mm (15, 32.5). The median distance (IQR) from the anal verge was 50 mm (50, 72.5). The median operative time (IQR) was 48.5 min (41.75, 60). All, except one lesion, were completely resected. The median length of stay (IQR) was one day (1, 1 day). Postoperative complications were diagnosed in three patients, two of which resolved following a second operation. CONCLUSIONS The implementation of TEM for the resection of RRLs demonstrated excellent overall results with acceptable complication and recurrence rate and represented a viable alternative surgical approach.
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Affiliation(s)
- F Salameh
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel.
| | - H Gilshtein
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
| | - R Abramov
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - I Ashkenazi
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
| | - D Duek
- Department of General Surgery, Rambam Health Care Campus, HaAliya HaShniya St 8, Haifa, Israel
- Colorectal Unit, Rambam Health Care Campus, Haifa, Israel
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Lei L, Zhong D, Zou J, Wang H, Yang H, Zhao Y, Liu J, Cheng D, Wu F. Oncological outcomes of early stage glottic squamous cell carcinoma treated with transoral laser microsurgery. Am J Otolaryngol 2020; 41:102364. [PMID: 31924412 DOI: 10.1016/j.amjoto.2019.102364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023]
Abstract
MATERIALS AND METHODS The records of patients treated with TLM with previously untreated early stage glottic squamous cell carcinoma were reviewed. RESULTS A total of 201 patients were enrolled: 191 men (95.0%) and 10 women (4.98%). The anterior commissure (AC) was involved in 94 (47.8%) patients. The 3- and 5-year overall survival rates of all patients were 94.5% and 90.9%. The local recurrence rates were 30.8% in the AC involvement (AC+) group and 16.0% in the group without AC involvement (AC-). The mortality rates were 18.1% and 3.7% in the AC+ and AC- groups. The 3- and 5-year disease-free survival rates were lower in the AC+ group (89.1%, 82.5%) than that in AC- group (99.0%, 96.5%). Local recurrence rates were 25%, 22.7%, 23.4%, and 22.1% for Tis, T1a, T1b, and T2 lesions. The mortality rates were 0.0%, 4.6%, 12.8%, and 15.3%. Three- and 5-year disease-free survival rates did not differ significantly between the tumor stage subgroups. The mortality for patients with local recurrence was 22.2%, which was higher than that for those without recurrence. The organ preservation rate was 98.5%. PURPOSE This study was to assess the rates of oncological outcomes in patients with early stage glottic squamous cell carcinoma treated with transoral laser microsurgery (TLM). CONCLUSION AC involvement was a predictor of local recurrence, and its presence was associated with a reduced survival rate and increased mortality after TLM. TLM got high survival rate and low recurrence rate. The staging and oncological outcomes did not differ between tumor stage subgroups.
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Affiliation(s)
- Lei Lei
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Daling Zhong
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jian Zou
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China.
| | - Haiyang Wang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Hui Yang
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Yu Zhao
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Jun Liu
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Danni Cheng
- The Department of Otorhinolaryngology, Head & Neck Surgery, West China Hospital, West China Medical School, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, Sichuan, China
| | - Fumei Wu
- The Department of Traditional Chinese Medicine Hospital, Section 2, Huayuan Road, Shuangliu District, Chengdu, Sichuan, China
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Tevlin R, Wan DC, Momeni A. Should free deep inferior epigastric artery perforator flaps be considered a quality indicator in breast reconstruction? J Plast Reconstr Aesthet Surg 2019; 72:1923-1929. [PMID: 31570216 DOI: 10.1016/j.bjps.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/15/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Abstract
Over the past several decades, technical advances in breast reconstruction have resulted in the development of flaps that are aimed at progressively decreasing abdominal wall morbidity. There is, however, ongoing controversy related to the superiority of deep inferior epigastric perforator (DIEP) flaps over muscle-sparing TRAM (MS-TRAM) flaps. Hence, the question remains unanswered as to which approach should be considered the standard of care, and more importantly, whether the rate of DIEP flap utilization should be considered a quality metric in breast reconstruction. In this review article, we examine the literature pertaining to abdominal free tissue transfer in breast reconstruction from both donor site and flap characteristics as well as the resultant complications and morbidity. The impact on the donor site remains a prevailing principle for autologous breast reconstruction; thus, must be adequately respected when classifying what is left behind following flap harvest. The most commonly used nomenclature is too simplistic. This, in turn, leads to inadequate incorporation of critical variables, such as degree of muscular preservation, fascial involvement, mesh implantation, and segmental nerve anatomy. Currently, there is insufficient evidence to support DIEP flap harvest as a quality indicator in breast reconstruction, as DIEP flap outcomes are not clearly superior when compared with MS-TRAM flaps.
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Affiliation(s)
- Ruth Tevlin
- Division of Plastic and Reconstructive Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, Palo Alto, CA 94304, United States
| | - Derrick C Wan
- Division of Plastic and Reconstructive Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, Palo Alto, CA 94304, United States
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, 770 Welch Road, Suite 400, Stanford, Palo Alto, CA 94304, United States.
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Dang H, de Vos Tot Nederveen Cappel WH, van der Zwaan SMS, van den Akker-van Marle ME, van Westreenen HL, Backes Y, Moons LMG, Holman FA, Peeters KCMJ, van der Kraan J, Langers AMJ, Lijfering WM, Hardwick JCH, Boonstra JJ. Quality of life and fear of cancer recurrence in T1 colorectal cancer patients treated with endoscopic or surgical tumor resection. Gastrointest Endosc 2019; 89:533-544. [PMID: 30273589 DOI: 10.1016/j.gie.2018.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To optimize therapeutic decision-making in early invasive colorectal cancer (T1 CRC) patients, it is important to elicit the patient's perspective next to considering medical outcome. Because empirical data on patient-reported impact of different treatment options are lacking, we evaluated patients' quality of life, perceived time to recovery, and fear of cancer recurrence after endoscopic or surgical treatment for T1 CRC. METHODS In this cross-sectional study, we selected patients with histologically confirmed T1 CRC who participated in the Dutch Bowel Cancer Screening Programme and received endoscopic or surgical treatment between January 2014 and July 2017. Quality of life was measured using the European Organization for Research and Treatment 30-item Core Quality of Life Questionnaire and the 5-level EuroQoL 5-dimension questionnaire. We used the Cancer Worry Scale (CWS) to evaluate patients' fear of cancer recurrence. A question on perceived time to recovery after treatment was also included in the set of questionnaires sent to patients. RESULTS Of all 119 eligible patients, 92.4% responded to the questionnaire (endoscopy group, 55/62; surgery group, 55/57). Compared with the surgery group, perceived time to recovery was on average 3 months shorter in endoscopically treated patients after adjustment for confounders (19.9 days vs 111.3 days; P = .001). The 2 treatment groups were comparable with regard to global quality of life, functioning domains, and symptom severity scores. Moreover, patients in the endoscopy group did not report more fear of cancer recurrence than those in the surgery group (CWS score, 0-40; endoscopy 7.6 vs surgery 9.7; P = .140). CONCLUSIONS From the patient's perspective, endoscopic treatment provides a quicker recovery than surgery, without provoking more fear of cancer recurrence or any deterioration in quality of life. These results contribute to the shared therapeutic decision-making process of clinicians and T1 CRC patients.
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Affiliation(s)
- Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Sarita M S van der Zwaan
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Yara Backes
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Alexandra M J Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - James C H Hardwick
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Koedam TWA, Veltcamp Helbach M, van Oostendorp SE, Tuynman JB, Sietses C. [Application of flexible transanal port for excision of rectal tumours]. Ned Tijdschr Geneeskd 2018; 162:D2316. [PMID: 30020574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In 2010 the first report of the application of the flexible transanal port ('operation platform') for the excision of rectal tumours was published. Due to the enhanced vision it provides, adenomas and small malignant rectal tumours can be radically resected with significantly fewer recurrences than with endoscopic mucosal resection or transanal excisions done without this platform. The application of this platform is cheaper and more intuitive than transanal endoscopic microsurgery, while the quality of the local resection, the risk of postoperative complications and the functional and oncological outcomes all appear to be comparable. This is the reason that this flexible platform is now in use in most Dutch hospitals. The flexible port has led to an increase in rectum-sparing treatment for low-risk T1 rectal carcinoma. Nowadays, this platform is also used for the transanal approach during radical rectal surgery for high-risk rectal carcinomas and for rectal operations in patients with benign conditions in the pelvis minor such as severe endometriosis or Crohn's disease.
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Bronzwaer MES, Musters GD, Barendse RM, Koens L, de Graaf EJR, Doornebosch PG, Schwartz MP, Consten ECJ, Schoon EJ, de Hingh IHJT, Tanis PJ, Dekker E, Fockens P. The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas. Gastrointest Endosc 2018; 87:862-871.e1. [PMID: 29030001 DOI: 10.1016/j.gie.2017.09.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Large non-pedunculated rectal polyps are most commonly resected by endoscopic mucosal resection (EMR) or transanal endoscopic microsurgery (TEM). Despite pre-procedural diagnostics, unexpected rectal cancer is incidentally encountered within the resected specimen. This study aimed to compare the diagnostic assessment and procedural characteristics of lesions with and without unexpected submucosal invasion. METHODS A post-hoc analysis of a multicenter randomized trial (TREND study) was performed in which patients with a non-pedunculated rectal polyp of ≥3 cm without endoscopic suspicion of invasive growth were randomized between EMR and TEM. RESULTS Unexpected rectal cancer was detected in 13% (27/203) of patients; 15 after EMR and 12 after TEM. Most consisted of low-risk T1 cancers (78%, n = 18). There were no differences in the diagnostic assessment between lesions with and without unexpected submucosal invasion. Diagnostic biopsies revealed similar rates of high-grade dysplasia (28% [7/25] vs 18% [26/144]). When compared with EMR of adenomas, EMR procedures of unexpected cancers had a lower success rate of submucosal lifting (60% vs 93%, P < .001), were more often assessed as endoscopically incomplete (33% vs 10%, P = .01), and were more frequently terminated prematurely (60% vs 8%, P = .001). CONCLUSIONS Diagnostic assessment of large non-pedunculated rectal polyps revealed similar characteristics between unexpected cancers and adenomas. Unexpected cancers during EMR were non-lifting in 40%, endoscopically assessed as incomplete in 33%, and terminated prematurely in 60%. In treatment-naive patients, these factors should raise suspicion of malignancy and need discussion in a multidisciplinary team meeting for decision on further treatment strategies.
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Affiliation(s)
- Maxime E S Bronzwaer
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gijsbert D Musters
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Renée M Barendse
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan de Ijssel, the Netherlands
| | - Pascal G Doornebosch
- Department of Surgery, IJsselland Hospital, Capelle aan de Ijssel, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Amersfoort, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Donofrio CA, Losa M, Gemma M, Giudice L, Barzaghi LR, Mortini P. Safety of transsphenoidal microsurgical approach in patients with an ACTH-secreting pituitary adenoma. Endocrine 2017; 58:303-311. [PMID: 28005257 DOI: 10.1007/s12020-016-1214-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Patients affected by Cushing's disease often have important comorbidities directly linked to hypercortisolism that might enhance the operative risk. We report the safety of transsphenoidal surgery in patients affected by Cushing's disease as compared with patients with nonfunctioning pituitary adenoma. METHODS We have retrospectively analyzed 142 patients with Cushing's disease and 299 patients with nonfunctioning pituitary adenoma who underwent transsphenoidal surgery performed by a single experienced neurosurgeon between September 2007 and December 2014. For all of them, an intraoperative computerized anesthetic record for the automatic storage of data was available. RESULTS The intraoperative vital parameters and the frequency of drugs administered during anesthesia were comparable between Cushing's disease and nonfunctioning pituitary adenoma groups. The duration of surgery was similar between the two groups (41.2 ± 11.8 vs. 42.9 ± 15.6 min), while the duration of anesthesia was slightly shorter in Cushing's disease patients (97.6 ± 18.1 min) than in nonfunctioning pituitary adenoma patients (101.6 ± 20.6 min, p = 0.04). The total perioperative mortality rate was 0.2% (0% in Cushing's disease vs. 0.3% in nonfunctioning pituitary adenoma). Cushing's disease patients had surgical and medical complication rates of 3.5% each, not different from those occurring in nonfunctioning pituitary adenoma. The postoperative incidence of diabetes insipidus (10.6%) and isolated hyponatremia (10.6%) in Cushing's disease patients was significantly higher than in nonfunctioning pituitary adenoma patients (4.4 and 4.1%; p = 0.02 and p = 0.01, respectively). CONCLUSIONS In a large series of unselected and consecutive patients with Cushing's disease, transsphenoidal surgery performed by one dedicated experienced neurosurgeon had a reasonably low risk of complications. In particular, despite the higher burden of comorbidities typically associated with hypercortisolism, medical complications are rare and no more frequent than in patients with nonfunctioning pituitary adenoma.
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Affiliation(s)
- Carmine Antonio Donofrio
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Marco Losa
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Marco Gemma
- Service of Anesthesia and Intensive Care Unit, Head and Neck Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lodoviga Giudice
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lina Raffaella Barzaghi
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Pituitary Unit of the Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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Lin G. [Standardized development of transanal endoscopic microsurgery]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:852-856. [PMID: 28836241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Transanal endoscopic microsurgery (TEM) is currently the only one-port system in endoscopic surgery, which a direct endoluminal approach can lead to the target organ through a natural opening of human body. TEM has been applied in colorectal surgery for over 3 decades. Compared with radical surgery, TEM has the advantages, such as quicker recovery, shorter hospital stay and fewer complications. One perfect TEM surgical system, which mainly consists of three parts, namely peculiar rectoscope for surgery, special surgical instruments and imaging system, is the foundation of standardized development of TEM. Accurate preoperative evaluation and staging is the key for good outcomes in TEM technology. In addition to digital examination of rectum, rigid sigmoidoscopy(or rectoscopy) should be routinely performed to confirm the location of the lesion and record it in a "time-in-clock" form. For lesions with undetermined nature, biopsy should be performed. For patients with rectal tumor, pelvic MRI examination can be used on the basis of routine endorectal ultrasonography (ERUS). Endoluminal suture is the challenge for standardized development of TEM, especially for those with large intestinal wall defects. Professional training is required to master suture technique. In 2016, the consensus of experts on TEM technology was formulated by TEM Study Group of Colorectal Cancer Specialty Committee of Chinese Anticancer Association. The recommended surgical indications for TEM include (1)rectal adenoma; (2)early rectal cancer with good histopathological features; (3)extended resection of locally malignant polyps by colonoscopy; (4)other rectal tumors suitable for local resection; (5)benign stricture or anastomotic stricture of the rectum; (6)repair of anastomotic leakage after low anterior resection of rectum; (7)diagnosis of rectal hemorrhage; (8)biopsy of rectum and surrounding lesions; (9)repair of rectovaginal fistula or mucosal flap transposition of the internal mouth of anal fistula; (10)treatment of rectal foreign body. With the maturity of TEM technology, the indication of TEM continues to expand. Nowadays, TEM is applicable to rectal neuroendocrine tumor or gastrointestinal stromal tumor resection, as well as rectovaginal fistula repair. It can even serve as a "bottom-up" operation platform for transanal total mesorectal excision (taTME). This article introduces the standardization of TEM, its current indications, novel implications, and future perspectives, expecting that TEM will be further popularized and healthily developed in China.
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Affiliation(s)
- Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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10
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Mege D, Manceau G, Guedj N, Panis Y. Anterior rectal duplication treated with transanal endoscopic microsurgery. Tech Coloproctol 2017; 21:471-473. [PMID: 28501924 DOI: 10.1007/s10151-017-1623-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/16/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Diane Mege
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon HospitalAssistance Publique-Hôpitaux de Paris (AP-HP) University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Gilles Manceau
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon HospitalAssistance Publique-Hôpitaux de Paris (AP-HP) University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France
| | - Nathalie Guedj
- Department of Pathology, Beaujon HospitalAssistance Publique-Hôpitaux de Paris (AP-HP) University Denis Diderot, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD) Beaujon HospitalAssistance Publique-Hôpitaux de Paris (AP-HP) University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France.
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Guerrieri M, Ortenzi M, Lezoche G, Mancini S, Ghiselli R. Transanal endoscopic microsurgery in the treatment of large rectal adenomas. MINERVA CHIR 2016; 71:360-364. [PMID: 27892668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) is a minimally invasive technique allowing to excise large rectal adenomas by local approach. This study shows the feasibility and results of a long term experience of TEM applied in this field. METHODS A retrospective investigation was performed in patients affected by rectal adenomas (5-11 cm in diameter) who had undergone transanal endoscopic microsurgery from 1992 to 2015. A series of 207 patients met the inclusion criteria and were analyzed for characteristics, intraoperative and postoperative results and long-term follow-up. RESULTS Median age was 71 years (52-83 years). Of the 207 total patients, 77 were women (37.2%) and 130 men (62.8%). Median distance from the anal verge was 8 cm (4-20 cm). Median size was 6 cm, with lesion ranging from 5 to 11 cm in diameter. Median operative time was 57 minutes (42-90 minutes). We observed 17 (8.2%) minor complications and 2 (0.9%) major complication according to the Clavien-Dindo classification. We did not observe any intraoperative or post-operative mortality. Histological examination showed preoperative undiagnosed cancer in 8 (3.8%) cases in which the pathologist revealed adenocarcinoma staged as T1 Sm1 according to the Kikuchi classification. The median follow-up was 115 months (12-288 months). Six recurrences (2.9%), we observed with a median time for recurrence of 14 months. CONCLUSIONS TEM provides excellent oncological outcomes in the treatment of large benign rectal lesions, ensuring a minimal risk of resection margin infiltration at pathological examination, and is associated with low risk of complications.
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Affiliation(s)
- Mario Guerrieri
- Surgery Clinic, Marche Polytechnic University, Ancona, Italy -
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Melin AA, Kalaskar S, Taylor L, Thompson JS, Ternent C, Langenfeld SJ. Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior? Am J Surg 2016; 212:1063-1067. [PMID: 27810138 DOI: 10.1016/j.amjsurg.2016.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) have been shown to improve the quality of transanal resections, allowing for improved visibility and access to the proximal rectum. This study compares the short-term outcomes between TEM and TAMIS among experienced colorectal surgeons. METHOD A retrospective review was conducted for TEM and TAMIS performed from 2012 to 2015 by local colorectal surgeons. Baseline patient demographics, operative variables, pathology results, and short-term outcomes were assessed. RESULTS Sixty-nine patients were identified (40 TEM and 29 TAMIS). Patient demographics, tumor characteristics, operative variables, margin status, and postoperative complications were similar for both. Volume of resection was higher for TAMIS (P < .001). Lymph node retrieval was achieved in 17.2% of TAMIS cases compared with 0% of TEM (P = .01). CONCLUSIONS TAMIS appears to have equivalent indications and outcomes compared with TEM. TAMIS is associated with larger specimens and more frequent presence of mesorectal lymph nodes.
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Affiliation(s)
- Alyson A Melin
- Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
| | - Sudhir Kalaskar
- Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Lindsay Taylor
- Department of General Surgery, Colon and Rectal Surgery Inc., Omaha, NE, USA
| | - Jon S Thompson
- Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
| | - Charles Ternent
- Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA; Department of General Surgery, Colon and Rectal Surgery Inc., Omaha, NE, USA; Department of General Surgery, Methodist Hospital, Omaha, NE, USA; Department of General Surgery, Creighton University Medical Center, Omaha, NE, USA
| | - Sean J Langenfeld
- Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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Chiniah M, Ganganah O, Cheng Y, Sah SK. Transanal endoscopic microsurgery is an oncologically safe alternative to total mesorectal excision for stage I rectal cancer: results of a meta-analysis of randomized controlled trials. Int J Colorectal Dis 2016; 31:1501-4. [PMID: 26861705 DOI: 10.1007/s00384-016-2530-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Manu Chiniah
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 40016, People's Republic of China.
| | - Oormila Ganganah
- The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 40016, People's Republic of China
| | - Yong Cheng
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1, Youyi Road, Yuzhong, Chongqing, 40016, People's Republic of China
| | - Shambhu Kumar Sah
- The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 40016, People's Republic of China
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14
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Koessler T, Bichard P, Lepilliez V, Puppa G, Ris F, Roth A. [Epidemiology, treatment and follow-up of colorectal polyps]. Rev Med Suisse 2016; 12:982-988. [PMID: 27424425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Colorectal polyps are frequent in the general population. The diagnostic is made by endoscopy. Polyp's characteristics determine the technic to be used to remove them. Transanal endoscopic microsurgery offers an alternative to radical surgery for large rectal polyps or rectal tumors with low risk of node invasion. One peace resection is necessary to evaluate the resection margins. Lymphatic invasion, ≥ 1 mm submucosae invasion, tumor budding and poorly differentiated tumor are the four main risk factors for node invasion. In case of high risk of lymph node invasion a radical surgery is recommended. Surveillance must be adapted to the polyp type, their number, size, presence of a carcinomatous component as well as age and clinical status of the patient.
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Arezzo A. To TEM or not to TEM: past, present and probable future perspectives of the transanal endoscopic microsurgery platform. Tech Coloproctol 2016; 20:271-272. [PMID: 26956835 DOI: 10.1007/s10151-016-1445-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 01/31/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A Arezzo
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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Shelygin YA, Chernyshov SV, Mainovskaya OA, Zarodnyuk IV, Orlova LP, Rybakov EG. [Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment?]. ACTA ACUST UNITED AC 2016; 71:3223-31. [PMID: 29297651 DOI: 10.15690/vramn719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience. Methods The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI. Results Three hundred and thirty patients [mean age of 61,4±10 (33–88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6–10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0–14.0). Preoperative biopsy revealed: adenoma ― 263/330 (79,7%), adenocarcinoma ― 67/330 (20,3%). The median operating time was 40 (15–220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1–57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence. Conclusion Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.
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Maggiori L, Panis Y. Controversies in the management of early rectal cancer. MINERVA CHIR 2015; 70:467-480. [PMID: 26375899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Proctectomy with total mesorectal excision (TME) is the gold standard for rectal cancer surgical management, as it offers optimal oncologic results. However, this radical procedure is impaired by significant drawbacks, including temporary diverting stoma, risk of permanent stoma, high risk of postoperative morbidity, and long-term risk of postoperative bowel, urinary, and sexual disorders. These results led some authors to define "early rectal cancer" in an attempt to propose alternative strategies such as local excision in order to avoid radical surgery. Indeed, local surgery does not involve diverting stoma, has the advantage of sphincter-preservation even for very low rectal tumors, is associated with very good short-term results and accounts for a nearly nil long-term risk of bowel dysfunction or urogenital disorders. However, local excision, as opposed to TME, does not allow lymph node resection and staging. Its indication has therefore been the subject of debate. Finally, the recent description of organ preservation strategies, which concept lies in the avoidance of radical surgery, has recently been the subject of a high number of publications, including some poor-prognosis early rectal cancer. Recently, early rectal cancer has therefore become an intense field of research. In this review, we will assess described strategies and controversies regarding early rectal cancer management.
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Affiliation(s)
- L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance publique‑Hôpitaux de Paris,Université Paris VII, Clichy, France -
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Lu JY, Lin GL, Qiu HZ, Xiao Y, Wu B, Zhou JL. Comparison of Transanal Endoscopic Microsurgery and Total Mesorectal Excision in the Treatment of T1 Rectal Cancer: A Meta-Analysis. PLoS One 2015; 10:e0141427. [PMID: 26505895 PMCID: PMC4624726 DOI: 10.1371/journal.pone.0141427] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/11/2015] [Indexed: 12/29/2022] Open
Abstract
Background Transanal endoscopic microsurgery (TEM) for the treatment of early-stage rectal cancer has attracted attention due to its advantages of reduced surgical trauma, fewer complications, low operative mortality, rapid postoperative recovery and short hospital stay. However, there are still significant controversies regarding TEM for the treatment of rectal cancer, mainly related to the prognosis associated with this method. Objective This study sought to compare the efficacy of transanal endoscopic microsurgery (TEM) and total mesorectal excision (TME) for the treatment of T1 rectal cancer. Methods We searched the Cochrane Library, PubMed, Embase and CNKI databases. Based on the Cochrane Handbook for Systematic Reviews, we screened the trials, evaluated the quality and extracted the data. Results One randomized controlled trial (RCT) and six non-randomized controlled clinical trials (CCTs) were included in the meta-analysis (a total of 860 rectal cancer patients were included; 303 patients were treated with TEM, and 557 patients were treated with TME). Analysis revealed that all seven studies reported local recurrence rates, and there was a significant difference between the TEM and TME groups [odds ratio (OR) = 4.62, 95% confidence interval (CI) (2.03, 10.53), P = 0.0003]. A total of five studies reported distant metastasis rates, and there was no significant difference between the TEM and TME groups [OR = 0.74, 95%CI (0.32, 1.72), P = 0.49]. A total of six studies reported postoperative overall survival of the patients, and there was no significant difference between the TEM and TME groups [OR = 0.87, 95%CI(0.55, 1.38), P = 0.55]. In addition, two studies reported the postoperative disease-free survival rates of patients, and there was no significant difference between the TEM and TME groups [OR = 1.12, 95%CI (0.31, 4.12), P = 0.86]. Conclusions For patients with T1 rectal cancer, the distant metastasis, overall survival and disease-free survival rates did not differ between the TEM and TME groups, although the local recurrence rate after TEM was higher than that after TME.
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Affiliation(s)
- Jun-Yang Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
| | - Guo-Le Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
- * E-mail:
| | - Hui-Zhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
| | - Jiao-Lin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China 100730
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Kong X, Liu Q, Lin G, Zhao D, Qiu H, Cui Q. The first attempt in local excision of anorectal malignant melanoma using transanal endoscopic microsurgery. Int J Clin Exp Pathol 2015; 8:11735-11740. [PMID: 26617919 PMCID: PMC4637735] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/20/2015] [Indexed: 06/05/2023]
Abstract
Anorectal malignant melanoma (AMM) is an uncommon malignancy that is thought to arise from melanocytes in the mucosa around the anorectal junction. AMM is commonly misdiagnosed, and definitive preoperative diagnosis is often difficult. The prognosis of AMM is relatively poor. Although radical resection is required for AMM, there is still no consensus at this moment on which surgical approach is preferred. We herein report a rare case of AMM which was treated by transanal endoscopic microsurgery (TEM) in combination with radiotherapy, which resulted in complete excision of the lesion without complications. The successful treatment for this AMM using TEM emphasizes the need to broaden its application in the treatment of various rectal lesions while preserving organ function and decreasing recurrence.
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Affiliation(s)
- Xiangyi Kong
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
| | - Qi Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
| | - Huizhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
| | - Quancai Cui
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesNo. 1 Shuaifuyuan Hutong of Dongcheng District, Beijing 100730, P. R. China
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Molina G, Bordeianou L, Shellito P, Sylla P. Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 2015; 30:1816-25. [PMID: 26264697 DOI: 10.1007/s00464-015-4452-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/13/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peritoneal entry during transanal endoscopic microsurgery (TEM) can usually be managed transanally with full-thickness suture closure by experienced operators. The preliminary safety of transanal minimally invasive surgery (TAMIS) has been demonstrated, but the reported experience with upper rectal tumors is limited. The incidence and management of peritoneal entry during transanal endoscopic surgery across various platforms have not been previously evaluated. METHODS Retrospective analysis of a prospectively maintained database of all transanal endoscopic resections performed at a single institution between January 2008 and December 2014 was conducted. Cases with and without peritoneal entry were evaluated with respect to transanal platform used, surgical indication, size, location and distance from the anal verge, and incidence of postoperative complications. RESULTS A total of 78 transanal endoscopic procedures were performed on 76 patients using the rigid transanal endoscopic operation (TEO, 65.4 %), TEM (26.9 %), and TAMIS platform (7.7 %). The most common surgical indication included endoscopically unresectable adenomas (50 %). The average distance of lesions from the anal verge (AV) was 9.6 cm (range 4-20 cm). Peritoneal entry occurred in 22 cases (28.2 %). Platform used (TAMIS vs. rigid, p < 0.05), mean distance from the AV (p < 0.0001), location along the rectum (p = 0.01), and mean specimen size (p = 0.01) were associated with a higher likelihood of peritoneal entry. All rectal defects associated with peritoneal entry were successfully closed transanally except for two (TEM and TEO) cases that required conversion to laparoscopic low anterior resection and laparoscopic Hartmann's, respectively. There were four TAMIS cases that required conversion to TEO platforms. CONCLUSION In this high-risk TEM, TEO, and TAMIS series (one-third of rectal lesions located in the upper rectum), 91 % of all peritoneal entries were managed transanally without increased morbidity. TAMIS for upper rectal lesions was associated with a high risk of complicated peritoneal entry requiring conversion to a rigid platform.
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Affiliation(s)
- George Molina
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | - Paul Shellito
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Patricia Sylla
- Department of Surgery, Mount Sinai Hospital, 5 East 98th Street Box 1249, New York, NY, 10029, USA.
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