scholarly journals Transanal endoscopic microsurgery in the treatment of patients with benign neoplasms and early rectal cancer

2022 ◽  
Vol 20 (6) ◽  
pp. 13-22
Author(s):  
V. A. Avdeenko ◽  
A. A. Nevolskikh ◽  
A. R. Brodsky ◽  
R. F. Zibirov ◽  
I. A. Orekhov ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Tumor Invasion ◽  
Transanal Endoscopic Microsurgery ◽  
Rectal Neoplasms ◽  
Tumor Response ◽  
Chemoradiation Therapy ◽  
Early Rectal Cancer ◽  
Duration Of Surgery ◽  
Endoscopic Microsurgery

Introduction. Transanal endoscopic microsurgery (tem) is a method that allows the specialists to clearly visualize a tumor and bimanually remove the tumor using a set of special instruments. For a number of patients with a good tumor response to chemoradiation therapy (crt), tem is used as an advanced biopsy technique for tumor verification. The purpose of the study was to analyze the results of tem performed at a. Tsyb mrrc. Material and methods. Between 2015 and 2020, 64 patients (men – 42.2 % and women – 57.8 %) underwent tem. Forty patients had rectal cancer and 25 patients had benign rectal tumors. The indication for tem in patients with rectal cancer was the evidence of tis-t1 tumor by postoperative examination findings (mri and endosonography). Eleven patients with stage ii–iii rectal cancer received chemoradiation therapy. The indication for performing tem after rt in patients with rectal cancer was a good tumor response (mri trg1- 2). For statistical processing, commercial biomedical packages prism 3.1 and instat (graphpad software, inc., san diego, usa) were used. The significance of the differences between the indicators was assessed using the pearson χ2 test. Differences were considered significant if the p value was less than 0.05. Results. The median duration of surgery was 110 minutes (30–385). The volume of blood loss did not exceed 40 ml. Postoperative complications were observed in 15 cases (23.4 %). Grade 3 complications according to the clavien-dindo classification were observed in 5 (7.8 %) cases. Postoperative complications occurred more frequently in patients after crt (10.7 and 18.2 %; p=0.603), however, the differences were not statistically significant. At a median follow-up of 18 months (7–30), local relapses developed in 6 out of 26 (23 %) patients who underwent surgery alone. There were no signs of local recurrence in patients with adenocarcinomas after neoadjuvant chemotherapy and rectal adenomas. When comparing patients with the depth of tumor invasion tis-t1sm2 and t1sm3-t2, local relapses occurred in 1 of 21 (4.7 %) and 5 of 12 (41.6 %) cases, respectively (p=0.015). Conclusion. The analysis of the results of tem interventions in patients with rectal neoplasms allows us to conclude that this method of treatment is a priority for patients with benign rectal neoplasms and early rectal cancer. The method can also be used after rt or crt in patients with tumor invasion ≥t1sm3, provided a complete or almost complete tumor response to the treatment.

scholarly journals TEM technique in the treatment of patients with early rectal cancer

2020 ◽  
Vol 179 (2) ◽  
pp. 55-58
Author(s):  
P. N. Romaschenko ◽  
A. A. Sazonov ◽  
N. A. Maistrenko ◽  
D. A. Ilyasbekov
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Transanal Endoscopic Microsurgery ◽  
Clinical Case ◽  
Rectal Neoplasms ◽  
Surgical Trauma ◽  
Early Rectal Cancer ◽  
Positive Potential ◽  
Important Direction ◽  
Endoscopic Microsurgery

The use of organ-preserving interventions remains the most important direction in improving of surgical treatment of patients with rectal cancer. One of the promising options for its implementation is the TEM (transanal endoscopic microsurgery) technique, which allows local removal of rectal neoplasms by its full-wall resection. However, indications for this intervention are still a matter of debate. The presented clinical case demonstrates the positive potential of the TEM technique, which consists of reducing surgical trauma without violating the basic oncological principles.

scholarly journals Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience

2019 ◽  
Vol 21 (10) ◽  
pp. 1164-1174 ◽  
Author(s):  
M. Ondhia ◽  
P. Tamvakeras ◽  
P. O'Toole ◽  
A. Montazerri ◽  
T. Andrews ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Early Rectal Cancer ◽  
Cancer Centre ◽  
Endoscopic Microsurgery

Transanal endoscopic microsurgery: results of the first 50 cases

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.

695 Transanal endoscopic microsurgery in early rectal cancer

1995 ◽  
Vol 31 ◽  
pp. S145
Author(s):  
F. Kayser ◽  
G. Buess ◽  
B. Mentges ◽  
K. Manncke ◽  
H.-D. Becker
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Early Rectal Cancer ◽  
Endoscopic Microsurgery

scholarly journals SYSTEMATIC REVIEW AND METAANALYSIS OF TRANSANAL ENDOSCOPIC MICROSURGERY VERSUS ENDOSCOPIC SUBMUCOSAL DISSECTION FOR RECTAL ADENOMAS AND EARLY RECTAL CANCER

2019 ◽  
Vol 18 (2) ◽  
pp. 7-20
Author(s):  
S. V. Chernyshov ◽  
M. A. Tarasov ◽  
M. A. Nagudov ◽  
D. A. Mtvralashvili ◽  
A. Likutov ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Rectal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Transanal Endoscopic Microsurgery ◽  
Meta Analysis ◽  
Early Colorectal Cancer ◽  
Early Rectal Cancer ◽  
Submucosal Dissection ◽  
Endoscopic Microsurgery

AIM: transanal endomicrosurgery (TEM) is the standard for organ-preserving treatment of patients with large adenomas and early rectal cancer. The advantage of TEM in comparison with other transanal methods of treatment of rectal tumors is the low frequency of R1 resections and fragmentation, which procudes a low level of local recurrences. Endoscopic submucosal dissection (ESD) is a new technology for superficial rectum tumors. This systematic review and meta-analysis compared safety and efficacy of ESD vs TEM for large adenoma and early colorectal cancer.PATIENTS AND METHODS: a literature search and meta-analysis of the data was carried out in accordance with the English-language Medline database without restrictions on the publication date (end December 18, 2018) according to keywords: «endoscopic submucosal dissection», «esd», «endoscopic dissection», «tem», «tamis», «transanal endoscopic microsurgery», «transanal resection», «teo», «transanal endoscopic microsurgical excision». The systematic review includes all papers on the comparison of TEM and ESD for large adenomas and early rectal cancer. Statistical data processing was performed using Review Manager 5.3.RESULTS: four retrospective comparative studies were included in the analysis (215 patients). Groups were homogenous in the number of tumors (Odds ratio [OR]=1,19; 95% confidence interval [CI] 0.23-6.16) and size (p=0.55). The intraoperative morbidity included bleeding (p=0.54) and rectal perforation (p=0.32) was homogenous as well. The operation time in the ESD group was significantly longer by 32 minutes than TEM (OR=32.5;95% CI 17,7-47.4; p<0.0001). Postoperative stay was higher than in 1.6 times after TEM (OR=16.1; 95% CI 1.5-30.1; p=0.03). The antibiotics use after surgery was not significantly different in both groups (p=0.33). The en-bloc resections (p=0.66) and the rate of R1 resections (p=0.74) were not significantly different in both groups. The local recurrence rate was homogenous (p=0.95).CONCLUSIONS: the ESD and TEM procedures are safe and effective techniques for local excision of adenomas and early colorectal cancer, but a randomized study is needed to prove the results.

scholarly journals Transanal endoscopic microsurgery (TEM) for early rectal cancer: single center experience

2013 ◽  
Vol 12 (3) ◽  
pp. 156-160
Author(s):  
Narimantas Evaldas Samalavičius ◽  
Marijus Ambrazevičius ◽  
Alfredas Kilius ◽  
Kęstutis Petrulis
Keyword(s):  
Rectal Cancer ◽  
Transanal Endoscopic Microsurgery ◽  
Survival Rates ◽  
Abdominoperineal Excision ◽  
Adjuvant Chemoradiotherapy ◽  
Early Rectal Cancer ◽  
Single Center Experience ◽  
Endoscopic Microsurgery ◽  
Lost To Follow Up

Background / objectiveTo evaluate the initial experience with transanal endoscopic microsurgery (TEM) for early rectal cancer in a single center.Patients and methodsFrom February 2010 to October 2012 a total of 16 patients underwent TEM for early rectal cancer. 7 were women and 9 men, age range 52 to 88 years (median – 71 years). Postoperative surveillance protocol, which includes rigid proctoscopy, CEA and endorectal ultrasound every 3 months during first two years, was applied to all patients after TEM.ResultsFinal histology revealed 10 (62.5% ) lesions to be T1 and 6 (37.5%) T2 cancers. There were no postoperative complications. All 6 patients in pT2 group and those in pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 1 to 27 months (median – 14 months). There was one local recurrence (6.25%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free.ConclusionsIn our hands, TEM was an alternative to standard total mesorectal excision in patients with low risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.Key words: early rectal cancer, transanal endoscopic microsurgery, recurrence, survival.Transanalinė endoskopinė mikrochirurgija anktyvam tiesiosios žarnos vėžiui gydyti Ligoniai ir metodaiNuo 2010 m. vasario iki 2012 m. spalio 16 pacientų, sergančių ankstyvuoju tiesiosios žarnos vėžiu, buvo gydyti TEM būdu (7 vyrai ir 9 moterys, amžius – nuo 52 iki 88 metų; mediana – 71 metai). Visiems pacientams buvo atliekama pooperacinėstebėsena: proktoskopija, endorektalinė sonoskopija ir CEA tyrimas kas 3 mėn. pirmus dvejus metus.RezultataiHistologinio tyrimo metu rasta 10 (62,5 %) T1 navikų ir 6 (37,5 %) T2 navikai. Artimųjų pooperacinių komplikacijų nebuvo. Visiems šešiems pT2 grupės pacientams ir pT1 didelės rizikos pacientams buvo pasiūlyta adjuvantinė chemoradioterapijaar skubus radikalus operacinis gydymas. Pacientai buvo stebimi nuo 1 iki 27 mėn. (mediana –14 mėn.). Vienam pacientui (6,25 %), atsisakiusiam abdominoperinealinės rezekcijos del žemo didelės rizikos T1 naviko, po chemospindulinio gydymonavikas atsinaujino. Po 7 mėn. šiam pacientui buvo atlikta abdominoperinealinė rezekcija (rpT2N0M0). Vienas pacientas pasitikrinti neatvyko. Kiti pacientai yra gyvi, jiems nėra recidyvo.IšvadosTEM yra alternatyvus gydymo metodas tradicinei totalinei mezorektalinei ekscizijai (TME) pacientams, sergantiems mažos rizikos tiesiosios žarnos vėžiu. Tolesnė stebėsena reikalinga siekiant įvertinti recidyvų dažnį ir išgyvenamumą po TEM esantinvazyviam tiesiosios žarnos vėžiui.Reikšminiai žodžiai: ankstyvas tiesiosios žarnos vėžys, gydymas, transanalinė endoskopinė mikrochirurgija.

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