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Surgical Endoscopy

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01-04-2018

The feasibility of laparoscopic rectal resection in patients undergoing reoperation after transanal endoscopic microsurgery (TEM)

Authors: M. Ortenzi, R. Ghiselli, A. Paolucci, M. Guerrieri

Published in: Surgical Endoscopy | Issue 4/2018

Abstract

Background

The success of transanal endoscopic microsurgery (TEM) for early rectal cancer depends on proper indications and strict patient selection. When unfavorable pathologic features are identified after TEM operation, total mesorectal excision is recommended to minimize the risk of recurrence. In this study, data were collected in a retrospective series of patients to determine the results of laparoscopic reoperation after TEM.

Methods

All patients underwent an accurate rectal-digital examination and clinical tumor staging by transanal endosonography, CT, and/or MRI. The histologic examination included an evaluation of the free margins, depth of tumor infiltration according to International Union Against Cancer guidelines, degree of tumor differentiation, and the presence of lymphovascular and perineural invasion. When a high-risk tumor was identified, reoperation was performed within 6 weeks from TEM. The patients were divided into two groups according to the procedure performed: laparoscopic anterior resection (LAR) or laparoscopic abdominal perineal amputation (LAPR).

Results

Sixty-eight patients (5.3%) underwent reoperation: 38 underwent LAR and 30 underwent LAPR. The mean operative time was 148.24 min (± 35.8, p = 0.62). Meanwhile, the mean distance of the TEM scar from the anal verge differed statistically between the two groups (p = 0.003) and was statistically correlated with abdominal perineal amputation (p = 0.0001) in multivariate analysis. Conversion to open surgery was required in 6 patients (15.7%) in the LAR group and 3 patients (10%) in the LAPR group (p = 0.38). The histologic examination revealed residual cancer cells in 3 cases (3 pT2N0) and 1 case (1 pT3N0), respectively, and lymph node metastases in 4 cases. No residual neoplasms were detected in the remaining 60 cases (88.3%). After a mean follow-up of 108 months, the overall disease-free survival was 98% (95% CI 88–99%).

Conclusions

In our experience, reoperation after TEM using a laparoscopic approach is feasible and safe, with low conversion rates and optimal postoperative results.

Borschitz T, Heintz A, Junginger T (2006) The influence of histopathologic criteria on the long term prognosis of locally excised pT1 rectalcarcinomas: results of local excision (transanal endoscopic microsurgery) and immediate reoperation. Dis Colon Rectum 49(10):1492–1506 (discussion 1500–1505)CrossRefPubMed

Mason AY (1976) President’s address. Rectal cancer: the spectrum of elective surgery. Proc R Soc Med 69:237–244PubMedPubMedCentral

UICC (1997). In: Sobin LH, Wittekind C (eds) TNM classification of malignant tumours, 5th edn. Wiley, New York

Hermanek P, Gall FP (1986) Early (microinvasive) colorectal carcinoma. Pathology, diagnosis, surgical treatment. Int J Colorectal Dis 1:79–84CrossRefPubMed

Quirke P (1998) The pathologist, the surgeon and colorectal cancer-get it right because it matters. Prog Pathol 4:201–214

Nagtegaal ID, van Krieken JHJM (2002) The role of pathologists in the quality control of diagnosis and treatment of rectal cancer—an overview. Eur J Cancer 38:964–972CrossRefPubMed

Clavien PA et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196CrossRefPubMed

Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B, Mortensen NJ (2009) Association of coloproctology of great Britain and Ireland transanal endoscopic microsurgery (TEM) collaboration. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96(3):280–290CrossRefPubMed

Hahnloser D, Wolff BG, Larson DW, Ping J, Nivatvongs S (2005) Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48(3):429–437CrossRefPubMed

10.

Lu JY, Lin GL, Qiu HZ, Xiao Y, Wu B, Zhou JL (2015) Comparison of transanal endoscopic microsurgery and total mesorectal excision in the treatment of T1 rectal cancer: a meta-analysis. PLoS ONE 10(10):e0141427CrossRefPubMedPubMedCentral

11.

Morino M, Allaix ME, Arolfo S, Arezzo A (2013) Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Surg Endosc 27(9):3315–3321CrossRefPubMed

12.

Kulig J, Richter P, Gurda-Duda A, Gach T, Klek S (2006) The role and value of endorectal ultrasonography in diagnosing T1 rectal tumors. Ultrasound Med Biol 32(4):469–472CrossRefPubMed

13.

Levic K, Bulut O, Hesselfeldt P, Bülow S (2013) The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study. Tech Coloproctol 17(4):397–403CrossRefPubMed

14.

Baron PL, Enker WE, Zakowski MF, Urmacher C (1995) Immediate versus salvage resection after local treatment for early rectal cancer. Dis Colon Rectum 38:177–181CrossRefPubMed

15.

Borschitz T, Heintz A, Junginger T (2007) Transanal endoscopic microsurgical excision of pT2 rectal cancer: results and possible indications. Dis Colon Rectum 50:292–301CrossRefPubMed

16.

Lee WY, Lee WS, Yun SH, Shin SH, Chun HK (2007) Decision for salvage treatment after transanal endoscopic microsurgery. Surg Endosc 21(6):975–979CrossRefPubMed

17.

Piessen G, Cabral C, Benoist S, Penna C, Nordlinger B (2012) Previous transanal full-thickness excision increases the morbidity of radical resection for rectal cancer. Colorectal Dis 14(4):445–452CrossRefPubMed

18.

Stipa F, Giaccaglia V, Burza A (2012) Management and outcome of local recurrence following transanal endoscopic microsurgery for rectal cancer. Dis Colon Rectum 55(3):262–269CrossRefPubMed

19.

Lezoche G, Guerrieri M, Baldarelli M, Paganini AM, D’Ambrosio G, Campagnacci R et al (2011) Transanal endoscopic microsurgery for 135 patients with small nonadvanced low rectal cancer (iT1–iT2, iN0): short-and long-term results. Surg Endosc 25(4):1222–1229CrossRefPubMed

20.

Chang AJ, Nahas CS, Araujo SE, Nahas SC, Marques CF, Kiss DR, Cecconello I (2008) Early rectal cancer: local excision or radical surgery? J Surg Educ 65(1):67–72CrossRefPubMed

Title: The feasibility of laparoscopic rectal resection in patients undergoing reoperation after transanal endoscopic microsurgery (TEM)
Authors: M. Ortenzi
R. Ghiselli
A. Paolucci
M. Guerrieri
Publication date: 01-04-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5898-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The feasibility of laparoscopic rectal resection in patients undergoing reoperation after transanal endoscopic microsurgery (TEM)

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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