Early Rectal Cancer: Can Transanal Endoscopic Microsurgery (TEM) Become the Standard Treatment?

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.

Download Full-text

Transanal endoscopic microsurgery: results of the first 50 cases

Acta medica Lituanica ◽

10.6001/actamedica.v19i1.2309 ◽

2012 ◽

Vol 19 (1) ◽

pp. 45-49

Author(s):

Narimantas Evaldas SAMALAVIČIUS ◽

Alfredas KILIUS ◽

Kęstutis PETRULIS ◽

Simona LETAUTIENĖ ◽

Rūta GRIGIENĖ ◽

...

Keyword(s):

Rectal Cancer ◽

Transanal Endoscopic Microsurgery ◽

Rectal Wall ◽

Anal Verge ◽

Abdominal Cavity ◽

Safety Margin ◽

Adjuvant Chemoradiotherapy ◽

Rectal Stricture ◽

Early Rectal Cancer ◽

Endoscopic Microsurgery

The aim of the study was to share the experience and first results of implementation of transanal endoscopic microsurgery (TEM) technique for the removal of rectal adenomas, early rectal cancer or rectal stricture in the Center of Oncosurgery, Oncology Institute of Vilnius University. Materials and methods. From October 2009 to October 2011, a total of 50 patients underwent TEM for rectal adenomas, early rectal cancer or rectal stricture. The patients were 25 women and 25 men, 31 to 87 years of age (average 65 years). Rectal lesions were from 0.9 to 7.0 cm in diameter, 3–13 cm from the anal verge. Full thickness excision with 1 cm safety margin was achieved in all cases except two (mucosal excision), followed by closing of the rectal wall defect in one-layer running monocryl 3.0 suture using silver clips. In one case (TEM was performed for T2 rectal cancer), abdominal cavity was penetrated and two-layer closure was preferred. Results. In these series of 50 patients there was 1 (2%) complication (cystitis). No postoperative exitus occurred. The hospitalisation period ranged from 2 to 13 days (average 6 days). Final histology revealed 30 (60%) tubular or villous adenomas, 6 (12%) carcinomas in situ (pTis), 7 (14%) T1, 4 (8%) T2 cancers, and well-differentiated neuroendocrine tumors in 3 (6%) were diagnosed. One patient underwent open partial TME in pT1 group; the tumor was in the upper third of rectum and preoperatively evaluated as pTis disease. In two cases (pT1 group) lymphovascular invasion was present on final pathology, so they were offered a postoperative adjuvant chemoradiotherapy. Other 4 patients in T1 group are under surveillance. All 4 patients with T2 lesions were offered adjuvant chemoradiotherapy, one patient refused further treatment. Conclusions. TEM is an alternative for transanal excision of rectal adenomas and early rectal cancer. Further follow-up is necessary to evaluate the recurrence rate of cancer in invasive cancer patients group.

Download Full-text

Anorectal Functional Results After Transanal Endoscopic Microsurgery in Benign and Early Malignant Tumors

World Journal of Surgery ◽

10.1007/s00268-010-0475-7 ◽

2010 ◽

Vol 34 (5) ◽

pp. 1128-1132 ◽

Cited By ~ 27

Author(s):

Zhiming Jin ◽

Lu Yin ◽

Lijun Xue ◽

Moubin Lin ◽

Qi Zheng

Keyword(s):

Transanal Endoscopic Microsurgery ◽

Malignant Tumors ◽

Functional Results ◽

Endoscopic Microsurgery

Download Full-text

Transanal endoscopic microsurgery – a case report

Nowa Medycyna ◽

10.25121/nm.2020.27.1.5 ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Szymon Głowacki ◽

Tomasz Pokładowski ◽

Jerzy Ogłuszka ◽

Feliks Orchowski

Keyword(s):

Transanal Endoscopic Microsurgery ◽

Anal Verge ◽

Resected Specimen ◽

Adjuvant Radiation ◽

Low Grade ◽

Absorbable Suture ◽

Rectal Tumour ◽

Neoplastic Lesion ◽

Low Grade Dysplasia ◽

Endoscopic Microsurgery

Transanal endoscopic microsurgery is currently a method of choice for adenomas located up to 20 cm from the anal verge, which cannot be removed using endoscopy. We present a case of a 67-year-old patient with rectal tumour, which was initially diagnosed as a neoplastic lesion with low-grade dysplasia and was treated using this method. We emphasise that this type of management is also advisable in the absence of the possibility of obtaining a histopathological result corresponding to the clinical features of the lesion. The tumour was located low in the distal rectum, reaching the sphincters on the posterior wall. The tumour had a diameter of 2 x 3.5 cm. Diagnostic imaging showed features suggestive of a neoplastic lesion. A complete resection of the tumour was performed using a surgical rectoscope. The wound was closed with a continuous, braided, absorbable suture. Hospital stay was 5 days. The resected specimen was diagnosed as G1 adenocarcinoma. A follow-up 4 weeks after the surgery showed a healed wound, with no signs of incontinence. Continence was assessed using the Wexner Continence Scale. After oncological consultation, the patient was qualified for adjuvant radiation therapy. Transanal endoscopic microsurgery (TEM) proved to be a safe and effective method in the presented case of rectal tumour with low-grade dysplasia.

Download Full-text

Occult adenocarcinoma in adenomas. Possibilities of diagnostic methods

Koloproktologia ◽

10.33878/2073-7556-2021-20-2-10-16 ◽

2021 ◽

Vol 20 (2) ◽

pp. 10-16

Author(s):

S. V. Chernyshov ◽

E. A. Khomyakov ◽

R. K. Sinitsyn ◽

Yu. E. Vaganov ◽

Yu. L. Trubacheva ◽

...

Keyword(s):

Anal Verge ◽

Digital Rectal Examination ◽

Diagnostic Value ◽

Diagnostic Methods ◽

Pelvic Mri ◽

Rectal Examination ◽

Occult Malignancy ◽

Endoscopic Microsurgery ◽

Pair Wise Comparison

Aim: to analyze the diagnostic value of the digital rectal examination, colonoscopy, MRI and ERUS for detecting occult adenocarcinoma in rectal adenomas.Patients and methods: the study included 100 patients with newly identified epithelial rectal neoplasms, which undergone transanal endoscopic microsurgery from December 2019 to December 2020. All the patients underwent digital rectal examination, colonoscopy, ERUS with sonoelastography, and pelvic MRI. The diagnostics value of this methods was estimated with determination of sensitivity and specificity.Results: the study included 67 (67%) females and 33 (33%) males. The mean age of the patients was 64.4 ± 10.7 years. The median distance from the tumor to the anal verge was 6.0 ± 2.9 cm. The sensitivity of the digital rectal examination in the occult malignancy verification was 0.44 (95% CI 0.24–0.65), specificity — 0.93 (95% CI 0.85–0.97). The sensitivity of the colonoscopy — 0.56 (95% CI 0.34–0.75), the specificity — 0.84 (95% CI 0.73–0.91). The sensitivity of MRI — 0.40 (95% CI 0.21–0.61), specificity — 0.89 (95% CI 0.80–0.95). The sensitivity of ERUS was 0.48 (95% CI 0.27–0.68), the specificity — 0.73 (95% CI 0.61–0.82). Pair wise comparison of diagnostic methods revealed the absence of significant differences in their diagnostic value (p > 0.05).Conclusion: at least one of diagnostic methods allows to verify the presence of malignant transformation in 100% of cases. So, only combination of diagnostic methods can help to choose the optimal treatment option.

Download Full-text

Minimizing the surgical approach for a rare disease: transanal endoscopic microsurgery for rectal schwannoma

Tumori Journal ◽

10.1177/0300891619856704 ◽

2019 ◽

Vol 105 (6) ◽

pp. NP52-NP56 ◽

Cited By ~ 1

Author(s):

Marcello Guaglio ◽

Filiberto Belli ◽

Alessandro Cesa Bianchi ◽

Luca Sorrentino ◽

Luigi Battaglia

Keyword(s):

Transanal Endoscopic Microsurgery ◽

Anal Verge ◽

Treatment Options ◽

Standard Of Care ◽

Surgical Approaches ◽

Invasive Approach ◽

Anterior Rectal Resection ◽

Organ Sparing ◽

Endoscopic Microsurgery ◽

Submucosal Lesion

Objective: Rectal schwannomas are extremely rare tumors and their surgical treatment is widely variable in literature. Transanal endoscopic microsurgery (TEM) approach could be a reasonable option for such lesions, offering an organ-sparing strategy, but evidence is scarce. Methods: We report a 69-year-old man with a rectal submucosal lesion at 10 cm from the anal verge, treated by TEM. A systematic literature review on surgical approaches in rectal schwannoma was performed. Results: The patient was successfully treated by TEM, with adequate excision of the submucosal lesion. Histopathology revealed a rectal schwannoma. No recurrence was found at 1-year endoscopic follow-up. Previous studies reported 23 cases of rectal schwannoma and several treatment options, but only 2 cases were treated by TEM. Anterior rectal resection was generally adopted in cases of large, symptomatic masses with inconclusive preoperative biopsy, while lesions with features suggestive of stromal tumors were preferentially treated by endoscopy or, if located in distal rectum, by transanal approaches. Conclusions: An organ-sparing minimally invasive approach should be the standard of care for rectal schwannomas. TEM could extend the indication for their endoscopic treatment, providing adequate excision even for larger schwannomas of the middle–upper rectum.

Download Full-text