Transanal endoscopic microsurgery (TEM) − our experience
Authors:
O. Robek; V. Čan; T. Svoboda; B. Hemmelová; Z. Kala; R. Hrivnák
Authors place of work:
Chirurgická klinika LF Masarykovy univerzity a FN Brno
přednosta: prof. MUDr. Z. Kala, CSc.
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 1, s. 33-39.
Category:
Original articles
Summary
Introduction:
The purpose of this paper is to present our experience with transanal endoscopic microsurgery (TEM) as an operative approach in a selected group of patients with rectal tumours.
Methods:
We present a retrospective study of 80 patients operated for rectal tumour using TEM. Specific preoperative and postoperative indicators were gathered and statistically evaluated. We assessed histological examination before the surgery and definitive histology of the resected tumour, resection depth and basic demographic data of our patients.
Results:
Our experience suggests that there is no significant difference between the age of patients according to sex, even if malignant and benign tumours are assessed separately. The majority of our operated patients were male patients, mean age of 64 years who were primarily referred to our department because of bleeding low-grade adenomas of the rectum. In 17 patients a malignant tumour was diagnosed based on final histopathologic examination. None of them had signs of malignancy before the surgery.
Conclusion:
In the hands of an experienced surgeon, TEM is a feasible option of radical removal of rectal, locally not advanced malignancies if within reach of TEM rectoscope. TEM is a safe procedure that does not result in any alteration of rectal sphincter functions. Possible false negative preoperative benign diagnosis leads us to approach radical removal of the tumour with full wall thickness resection. Although the posterior aspect of the rectum is an optimal location for the rectoscope, anterior tumours were found in almost one half of our patients. Considering technical feasibility of the rectal wall suture, the base of the tumour should not extend beyond one half of the rectal circumference. Low non-stenotising noninvasive tumours of the rectum are suitable for TEM. Our good results are particularly due to strict patient selection criteria, mastering the operating technique and long-time experience.
Key words:
transanal endoscopic microsurgery (TEM) − benign rectal tumours − rectal cancer
Zdroje
1. Arezzo A, Passera R, Saito Y, et al. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surgical Endoscopy 2014;28:427−38.
2. Bacic D, Durut I. Transanal endoscopic microsurgery (TEM) - alternative or a method of choice in treating tumors of the rectum with appropriately selected patients? Collegium Antropologicum 2014;38:1127−30.
3. Boebel M. Instruments for transanal endoscopic microsurgery (TEM). End Surg 1993;1:50−1.
4. Buess G, Mentges B, Manncke K, et al. Technique and results of trasanal endoscopic microsurgery in early rectal cancer. Am J Surg 1992;163:63−9.
5. Buess G, Raestrup H. Transanal endoscopic microsurgery. Surg Oncol Clin N Am 2001;10:709−31.
6. Buess G. Endoluminal rectal surgery. In: Cuschieri A, Buess G, Perissat J. Operative manual of endoscopic surgery. Berlin, Springer 1992:353.
7. Graaf DE, Burger JW, Van Ijsseldijk AL, et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Disease 2011;13:762−7.
8. Heintz A, Mörschel M, Junginger T. Rektumkarzinom. Optimierung der Therapie durch lokale Exzision. Zentralbl Chir 1999;124:436−40.
9. Hermanek P. Onkologische und histopathologische Grundlagen einer lokalen Therapie in kurativer Intention. In: Hermanek P, Marzoli GP. Lokale Therapie des Rektumkarzinoms. Berlin, Heidelberg, New York, Springer-Verlag 1994:7−14.
10. Léonadr D, Colin J, Reumue Ch, et al. Transanal endoscopic microsurgery: long- term experience, indication expansion, and technical improvements. Surgical Endoscopy 2012;26:312−22.
11. Levic K, Bulut O, Hesselfeldt T. Transanal endoscopic microsurgery for giant polyps of the rectum. Techniques in Coloproctology 2014;18:521−7.
12. Marks J, Frenkel JL, Greenleaf, CE. Transanal endoscopic microsurgery with entrance into the peritoneal cavity. Diseases of the Colon & Rectum 2014;57:1176−82.
13. Massari M, De Simone M, Cioffi U, et al. Value and limits of endorectal ultrasonography for preoperative staging of rectal carcinoma. Surg Laparosc Endosc 1998;8:438−44.
14. Maya A, Verenberg A, Oviedo M, et al. Learning curve for transanal endoscopic microsurgery: a single-center experience. Surgical Endoscopy 2014;28:1407−12.
15. Mentges B, Buess G, Schäfer MD, et al. Local therapy of rectal tumors. Dis Colon Rectum 1996;39:886−92.
16. Morino M, Allaix E, Famiglietti F, et al. Does peritoneal perforation affect short − and long-term outcomes after transanal endoscopic microsurgery? Surgical Endoscopy 2013;27:181−8.
17. Obrand DI, Gordon PH. Results of local excision of rectal carcinoma. Canadian Journal of Surgery 1996;39:463−8.
18. Potenti F, Wexner SD. Local resection of rectal cancer. Hepato-gastroenterology 2000;47:327−34.
19. Safi F, Berger HG. Morbidität und Letalität der operativen Therapie des colorectalen Carcinoms. Chirurg 1994;65:127−31.
20. Said S, Stippel D. Transanal endoscopic microsurgery in large, sessile adenomas of the rectum. A 10-years experience. Surg Endosc 1995;9:1106−12.
21. Sheligin I, Rybakov EG. Is the localization of the tumor in intra-peritoneal part of the rectum contraindication to transanal endoscopic microsurgery? Vestnik Khirurgii Imeni I. I. Grekova 2014;173:43−6.
22. Song Y, Yang G. Evaluation of anal function and quality of life after transanal endoscopic microsurgery. Chinese Journal of Gastrointestinal Surgery 2014;17:809−12.
23. Taylor RH, Hay JH, Chir B, et al. Transanal local excision of selected low rectal cancers. American Journal of Surgery 1998;175:360−3.
24. Winde G, Nottberg H, Keller R, et al. Surgical cure for early rectal carcinomas: Transanal endoscopic microsurgery vs anterior resection. Dis Col Rect 1996;39:969−6.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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