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Brand M, Reimer S, Reibetanz J, Flemming S, Kornmann M, Meining A. Endoscopic full thickness resection vs. transanal endoscopic microsurgery for local treatment of rectal neuroendocrine tumors - a retrospective analysis. Int J Colorectal Dis 2021; 36:971-6. [PMID: 33215239 DOI: 10.1007/s00384-020-03800-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Local treatment of small well-differentiated rectal neuroendocrine tumors (NETs) is recommended by current guidelines. However, although several endoscopic methods have been established, the highest R0 rate is achieved by transanal endoscopic microsurgery (TEM). Since a recently published study about endoscopic full thickness resection (eFTR) showed a R0 resection rate of 100%, the aim of this study was to evaluate both methods (eFTR vs. TEM). METHODS We retrospectively analyzed all patients with rectal NET treated either by TEM (1999-2018) or eFTR (2016-2019) in two tertiary centers (University Hospital Wuerzburg and Ulm). We analyzed clinical, procedural, and histopathological outcomes in both groups. RESULTS Twenty-eight patients with rectal NET received local treatment (TEM: 13; eFTR: 15). Most tumors were at stage T1a and grade G1 or G2 (in the TEM group two G3 NETs were staged T2 after neoadjuvant chemotherapy). In both groups, similar outcomes for en bloc resection rate, R0 resection rate, tumor size, or specimen size were found. No procedural adverse events were noted. Mean procedure time in the TEM group was 48.9 min and 19.2 min in the eFTR group. CONCLUSION eFTR is a convincing method for local treatment of small rectal NETs combining high safety and efficacy with short interventional time.
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Marks JH, Kunkel E, Salem JF, Martin C, Anderson B, Agarwal S. First clinical experience with single-port robotic transanal minimally invasive surgery (SP rTAMIS) for benign rectal neoplasms. Tech Coloproctol 2021; 25:117-24. [PMID: 33068190 DOI: 10.1007/s10151-020-02358-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND The new da Vinci Single-Port (SP) robot is a single-arm four-channel robotic system well suited for endoluminal surgery. We report our initial experience performing SP robotic transanal minimally invasive surgery (SP rTAMIS) for rectal neoplasms. METHODS Under Institutional Review Board approval, two patients with rectal neoplasms were prospectively enrolled for elective SP rTAMIS. The primary endpoint was to report the safety and feasibility of successful procedure completion with the SP robot. Secondary endpoints included patient characteristics and perioperative metrics. RESULTS Both patients underwent successful SP rTAMIS resection of rectal neoplasms without intraoperative complications or conversions. The lesions were 4.0 cm and 3.0 cm in size, located 6 cm and 7 cm cephalad to the anorectal ring. Excisions were full thickness with no piecemeal extractions or specimen fragmentation. Estimated blood loss was 0 mL and 30 mL. The mean excised area was 13.4 cm2 (22.7 cm2 and 9.0 cm2). The mean docking time was 5.25 min (range 2-8 min) and mean console time was 122.5 min (98 min and 147 min). Patients tolerated a liquid diet on postoperative day (POD) 0 and were discharged on POD 1 after tolerating a low residue diet and having bowel function. Pathology showed two adenomas with negative margins. There was no immediate or delayed morbidity or mortality. CONCLUSIONS Our initial experience indicates that SP rTAMIS is a safe and feasible approach for local excision of rectal lesions. While SP rTAMIS is very promising, more experience with this approach is necessary to determine its widespread applicability.
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McCarty TR, Bazarbashi AN, Hathorn KE, Thompson CC, Aihara H. Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis. Surg Endosc 2020; 34:1688-95. [PMID: 31292744 DOI: 10.1007/s00464-019-06945-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND While multiple studies have evaluated endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) to remove large rectal tumors, there remains a paucity of data to evaluate their comparative efficacy and safety. The primary aim of this study was to perform a structured systematic review and meta-analysis to compare efficacy and safety of ESD versus TEM for the treatment of rectal tumors. METHODS Individualized search strategies were developed from inception through November 2018 in accordance with PRISMA guidelines. Measured outcomes included pooled enbloc resection rates, margin-negative (R0) resection rates, procedure-associated adverse events, and rates of recurrence. This was a cumulative meta-analysis performed by calculating pooled proportions. Heterogeneity was assessed with Cochran Q test and I2 statistics, and publication bias by funnel plot using Egger and Begg tests. RESULTS Three studies (n = 158 patients; 55.22% male) were included in this meta-analysis. Patients with ESD compared to TEM had similar age (P = 0.090), rectal tumor size (P = 0.108), and diagnosis rate of adenoma to cancer (P = 0.53). ESD lesions were more proximal as compared to TEM (8.41 ± 3.49 vs. 5.11 ± 1.43 cm from the anal verge; P < 0.001). Procedure time and hospital stay were shorter for ESD compared to TEM [(79.78 ± 24.45 vs. 116.61 ± 19.35 min; P < 0.001) and (3.99 ± 0.32 vs. 5.83 ± 0.94 days; P < 0.001), respectively]. No significant differences between enbloc resection rates [OR 0.98 (95% CI 0.22-4.33); P = 0.98; I2 = 0.00%] and R0 resection rates [OR 1.16 (95% CI 0.36-3.76); P = 0.80; I2 = 0.00%] were noted between ESD and TEM. ESD and TEM reported similar rates of adverse events [OR 1.15 (95% CI 0.47-2.77); P = 0.80; I2 = 0.00%] and rates of recurrence [OR 0.46 (95% CI 0.07-3.14); P = 0.43; I2 = 0.00%]. CONCLUSION ESD and TEM possess similar rates of resection, adverse events, and recurrence for patients with large rectal tumors; however, ESD is associated with significantly shorter procedure times and duration of hospitalization. Future studies are needed to evaluate healthcare utilization for these two strategies.
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Serra-Aracil X, Pericay C, Golda T, Mora L, Targarona E, Delgado S, Reina A, Vallribera F, Enriquez-Navascues JM, Serra-Pla S, Garcia-Pacheco JC. Non-inferiority multicenter prospective randomized controlled study of rectal cancer T 2-T 3s (superficial) N 0, M 0 undergoing neoadjuvant treatment and local excision (TEM) vs total mesorectal excision (TME). Int J Colorectal Dis 2018; 33:241-249. [PMID: 29234923 DOI: 10.1007/s00384-017-2942-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE The standard treatment of rectal adenocarcinoma is total mesorectal excision (TME), in many cases requires a temporary or permanent stoma. TME is associated with high morbidity and genitourinary alterations. Transanal endoscopic microsurgery (TEM) allows access to tumors up to 20 cm from the anal verge, achieves minimal postoperative morbidity and mortality rates, and does not require an ostomy. The treatment of T2, N0, and M0 cancers remains controversial. Preoperative chemoradiotherapy (CRT) in association with TEM reduces local recurrence and increases survival. The TAU-TEM study aims to demonstrate the non-inferiority of the oncological outcomes and the improvement in morbidity and quality of life achieved with TEM compared with TME. METHODS Prospective, multicenter, randomized controlled non-inferiority trial includes patients with rectal adenocarcinoma less than 10 cm from the anal verge and up to 4 cm in size, staged as T2 or T3-superficial N0-M0. Patients will be randomized to two areas: CRT plus TEM or radical surgery (TME). Postoperative morbidity and mortality will be recorded and patients will complete the quality of life questionnaires before the start of treatment, after CRT in the CRT/TEM arm, and 6 months after surgery in both arms. The estimated sample size for the study is 173 patients. Patients will attend follow-up controls for local and systemic relapse. CONCLUSIONS This study aims to demonstrate the preservation of the rectum after preoperative CRT and TEM in rectal cancer stages T2-3s, N0, M0 and to determine the ability of this strategy to avoid the need for radical surgery (TME). TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01308190. Número de registro del Comité de Etica e Investigación Clínica (CEIC) del Hospital universitario Parc Taulí: TAU-TEM-2009-01.
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Affiliation(s)
- X Serra-Aracil
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Parc Tauli s/n. 08208, Sabadell, Spain.
| | - C Pericay
- Medical Oncology Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - T Golda
- Coloproctology Unit, General and Digestive Surgery Department, Bellvitge University Hospital, Barcelona, Spain
| | - L Mora
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Parc Tauli s/n. 08208, Sabadell, Spain
| | - E Targarona
- General and Digestive Surgery Department, Santa Creu and Sant Pau University Hospital, Barcelona, Spain
| | - S Delgado
- General and Digestive Surgery Department, Clinic University Hospital, Barcelona, Spain
| | - A Reina
- Coloproctology Unit, General and Digestive Surgery Department, Torrecardenas University Hospital, Almeria, Spain
| | - F Vallribera
- Coloproctology Unit, General and Digestive Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - S Serra-Pla
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Parc Tauli s/n. 08208, Sabadell, Spain
| | - J C Garcia-Pacheco
- Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Parc Tauli s/n. 08208, Sabadell, Spain
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Abstract
OBJECTIVE To investigate the clinical values of preoperative use of antibiotics in transanal endoscopic microsurgery (TEM). METHODS Thirty patients undergoing TEM surgery to treat rectal neoplasms in our hospital were selected in this study. All patients were randomly divided into two groups: antibiotic group that antibiotics were used before and after surgery, and control group that antibiotics were only used after surgery. Several markers were evaluated before and after surgery in all patients, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), changes procalcitonin (PCT), white blood cell count (WBC), neutrophils (NE%) and temperature (T). RESULTS The patients in the antibiotic group at the first and third days after surgery showed lower values of ESR, CRP, WBC, NE% and T than the control group (p < 0.05), furthermore, the WBC and NE% were significantly decreased at the third day after surgery compared with the first day after surgery. For the PCT, there was a significant difference in the first day after surgery between the two groups (p < 0.05), but no significant difference was observed between them at the third day after surgery (p > 0.05). CONCLUSION The preoperative use of antibiotics in TEM surgery to treat rectal neoplasms may become an effective method to reduce inflammation and prevent infecting after surgery, which will be verified by an amount of studies on large sample.
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Affiliation(s)
- Jingbo Chen
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China.,b Department of General Surgery , The Affiliated Hospital of Qingdao University , No. 16 Jiangsu Road, Qingdao 266071 , Shandong , China
| | - Yupeng Li
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Xiangpeng Xi
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Lili Qiao
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Mingyu Yang
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Lijian Xia
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Yanbing Zhou
- b Department of General Surgery , The Affiliated Hospital of Qingdao University , No. 16 Jiangsu Road, Qingdao 266071 , Shandong , China
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Senft JD, Carstensen B, Mischnik A, Warschkow R, Müller-Stich BP, Linke GR. Endolumenal colon occlusion reduces peritoneal contamination during a transrectal NOTES procedure: a controlled porcine survival study. Surg Endosc 2015; 30:2946-50. [PMID: 26487201 DOI: 10.1007/s00464-015-4582-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/02/2015] [Accepted: 09/19/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND To enable an efficient and enduring decontamination of the rectal mucosa during transanal endosocopic procedures, we developed a device for reversible endolumenal colon occlusion (ColoShield). The aim of this study was to assess the value of ColoShield in reducing peritoneal contamination during a transrectal procedure. METHODS Sixteen pigs underwent transrectal hybrid NOTES cholecystectomy after standardized disinfective rectal washout either with endolumenal colon occlusion using ColoShield (N = 8) or without colon occlusion (N = 8). Rectal swab samples were taken before and after rectal washout and at the end of the procedure. Peritoneal biopsies for microbiological evaluation were obtained at the end of the procedure and at necropsy 7 days after surgery. RESULTS Peritoneal contamination at the end of surgery was significantly lower using ColoShield compared to not using colon occlusion [13 (1/8) vs. 75 % (6/8); P = 0.012]. No significant differences were found regarding contamination of rectal swabs and peritoneal contamination at necropsy. CONCLUSION The application of ColoShield may increase the safety of transrectal NOTES and transanal endoscopic procedures by reducing peritoneal contamination and consecutive infectious complications.
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Affiliation(s)
- Jonas D Senft
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Benedict Carstensen
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexander Mischnik
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Rene Warschkow
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georg R Linke
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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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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D'Ambrosio G, Paganini AM, Balla A, Quaresima S, Ursi P, Bruzzone P, Picchetto A, Mattei FI, Lezoche E. Quality of life in non-early rectal cancer treated by neoadjuvant radio-chemotherapy and endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) versus laparoscopic total mesorectal excision. Surg Endosc 2015; 30:504-511. [PMID: 26045097 DOI: 10.1007/s00464-015-4232-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 12/15/2014] [Accepted: 04/20/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND In selected patients with N0 rectal cancer, endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Aim of this study is to evaluate the short- and medium-term quality of life (QoL) from a retrospective analysis of prospectively collected data in patients with iT2-iT3 N0-N+ rectal cancer, who underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT). METHODS Thirty patients with iT2-iT3 rectal cancer who underwent ELRR by TEM (n = 15) or LTME (n = 15) were enrolled in this study. The choice for one operation or the other was made on the basis of predefined criteria. QoL was evaluated by EORTC QLQ-C30 and QLQ-CR38 questionnaires at admission, after n-RCT and 1, 6, and 12 months after surgery. RESULTS No statistically significant differences in QoL evaluation were observed between the two groups, both at admission and after n-RCT. At 1 month after surgery, significantly better results in the ELRR group were observed by QLQ-C30 in: Nausea/Vomiting (p = 0.05), Appetite Loss (p = 0.003), Constipation (p = 0.05), and by QLQ-CR38 in: Body Image (p = 0.05), Sexual Functioning (p = 0.03), Future Perspective (p = 0.05) and Weight Loss (p = 0.036). At 6 months after surgery, a statistically significant worse impact after LTME was observed by QLQ-C30 in: Global Health Status (p = 0.05), Emotional Functioning (p = 0.021), Dyspnea (p = 0.008), Insomnia (p = 0.012), Appetite Loss (p = 0.014) and by QLQ-CR38 in Body Image (p = 0.05) and Defecation Problems (p = 0.001). At 1 year, the two groups were homogenous as assessed by QLQ-C30, whereas the QLQ-CR38 still showed better results of ELRR versus LTME in Body Image (p = 0.006), Defecation Problems (p = 0.01), and Weight Loss (p = 0.005). CONCLUSIONS Based on the present series, in selected patients, earlier restoration of patients' functions is observed after ELRR by TEM than after LTME.
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Affiliation(s)
- Giancarlo D'Ambrosio
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Alessandro M Paganini
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Andrea Balla
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Pietro Ursi
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Paolo Bruzzone
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Andrea Picchetto
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Fabrizio I Mattei
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Emanuele Lezoche
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
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Suzuki T, Suwa K, Hada T, Okamoto T, Fujita T, Yanaga K. Local excision of rectal schwannoma using transanal endoscopic microsurgery: A case report. Int J Surg Case Rep 2014; 5:1193-6. [PMID: 25437674 PMCID: PMC4275951 DOI: 10.1016/j.ijscr.2014.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Schwannoma is a neoplasm originating from the neural crest cells (schwann cells) that form nerve sheaths. These tumors are thought to be benign with little risk of malignant transformation. They rarely affect the gastrointestinal tract, and primary rectal involvement is extremely rare. Until 2013, only 11 cases of anorectal schwannoma have been reported. Optimal surgical treatment of rectal schwannoma has not been established. PRESENTATION OF CASE We herein describe a 70-year-old woman with a submucosal tumor arising from the posterior wall of the rectum with features mimicking a gastrointestinal stromal tumor. After discussing the operative procedures and obtaining written informed consent, we attempted local excision of the tumor using a transanal endoscopic microsurgery (TEM). The tumor was proved to be S-100 positive schwannoma on immuhistochemical studies. Her postoperative course was uneventful, and there is no evidence of tumor recurrence as of 6 months after surgical excision. DISCUSSION An extremely rare rectal schwannoma was successfully treated using a TEM without compromising anorectal function. CONCLUSION TEM is a feasible approach for local excision of rectal tumors with low risk of malignancy.
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Affiliation(s)
- Toshiaki Suzuki
- Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, Japan.
| | - Katsuhito Suwa
- Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, Japan
| | | | - Tomoyoshi Okamoto
- Department of Surgery, Daisan Hospital, The Jikei University School of Medicine, Japan
| | - Tetsuji Fujita
- Department of Surgery, The Jikei University School of Medicine, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, Japan
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