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International Journal of Colorectal Disease

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01-02-2016 | Original Article

Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM)

Authors: Angelo Restivo, Luigi Zorcolo, Giuseppe D’Alia, Francesca Cocco, Andrea Cossu, Francesco Scintu, Giuseppe Casula

Published in: International Journal of Colorectal Disease | Issue 2/2016

Abstract

Introduction

Transanal endoscopic microsurgery (TEM) is a consolidated technique for the excision of rectal tumors. However, many aspects relating to its morbidity, risk of functional alterations, and therapeutic outcomes are still unclear. The aim of this study was to assess the rate of morbidity and fecal incontinence after TEM, and to identify associated risk factors.

Methods

We prospectively recorded the clinical data of 157 patients who underwent TEM from 1996 to 2013. Among these, 89 patients answered a questionnaire for the assessment of fecal continence at a median follow-up time of 40 months.

Results

Intraoperative and postoperative TEM complication rates were 3.8 and 20.4 %. The mortality rate was 0.6 %. A distance from the anal verge of more than 6 cm correlated with a higher risk of perforation, while patients with cancer were more likely to have postoperative bleeding. Incontinence was reported by 32 (36 %) patients, of which 7 (8 %) experienced transitory symptoms only, while 25 (28 %) reported persistent symptoms. We found a correlation between patients receiving preoperative radiotherapy (RT) and the development of fecal incontinence. The recurrence rate was 3 % (1/32) in pT1, 80 % (4/5) in pT2, and 100 % (1/1) in pT3. After radiotherapy, 7 % (1/9) showed a good response (pT0-1), and 18 % (2/7) showed no response (pT2-3).

Conclusions

TEM is associated with low morbidity but the risk of developing functional alterations is not negligible and should be discussed with the patient before the operation. Good oncological outcomes are possible for early invasive cancers and for selected advanced cancers following a good response to preoperative RT.

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Title: Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM)
Authors: Angelo Restivo
Luigi Zorcolo
Giuseppe D’Alia
Francesca Cocco
Andrea Cossu
Francesco Scintu
Giuseppe Casula
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 2/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-015-2371-y

At a glance: The STEP trials

Springer Medicine

Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM)

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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