Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise (original) (raw)
Related papers
Surgical Endoscopy, 2013
Background Peritoneal perforation (PP) is frequently reported as a complication of transanal endoscopic microsurgery (TEM). Nevertheless, these concerns have only rarely been addressed in the literature, with no mention of the long-term oncologic consequences of PP. Methods A prospective database was analyzed with the intent to evaluate the influence of PP on the short-and long-term outcomes for patients undergoing TEM. Results Peritoneal perforation occurred in 28 (5.8 %) of 481 patients who underwent TEM for a rectal neoplasm. The conversion rate to abdominal surgery was 10.7 % (3/28). All the conversions occurred during the first 100 TEM procedures (3/100 vs 0/381; p = 0.007). The postoperative morbidity rate was 3.6 % (1/28), and the 30-day mortality was nil. Compared with the group of patients who had no peritoneal perforation, the PP group showed a significantly longer operating time (120 vs 60 min; p \ 0.001) and a significantly longer hospital stay (6 vs 4 days; p = 0.003). Nevertheless, the global morbidity rate and the type of complications according to Dindo's classification were similar. In the multivariate analysis, the only independent predictor of PP was tumor distance from the anal verge (p = 0.010). During a median follow-up period of 48 months (range, 12-150 months), no liver or peritoneal metastases were detected in 13 patients with rectal cancer. Conclusions Peritoneal perforation does not seem to affect short-term or oncologic outcomes for patients submitted to TEM with full-thickness resection for upper rectum neoplasms. The use of TEM to resect rectal lesions involving the intraperitoneal rectum may therefore represent an intermediate step toward the development of transrectal natural orifice translumenal endoscopic surgery (NOTES) techniques.
Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm
Surgical Endoscopy, 2011
Background Indications and results of local excision of rectal lesions are currently under debate. Transanal endoscopic microsurgery (TEM), allowing a precise, fullthickness excision, could improve oncological results in early rectal tumors. Methods A prospective database was analyzed with the intent to identify risk factors for recurrence after TEM. Results Among 355 patients subjected to TEM, 107 had an adenocarcinoma: 48 pT1, 43 pT2, and 16 pT3. Comparing pre-and postoperative data, histological discrepancy was 20% and staging discrepancy was 34%. Mortality was nil, morbidity was 9%. Mean follow-up was 54.2 months (range = 12-164), follow-up rate was 100%. The 5-year disease-free survival rate was 85.9, 78.4, and 49.4% for pT1, pT2, and pT3, respectively (p = 0.006). Recurrence rate was 0% (0/26) in pT1sm1 cancers and 22.7% (5/22) in sm2-3 (p \ 0.05). A submucosal infiltration represented a significant risk factor for recurrences: 0% sm1, 16.7% sm2, and 30% sm3. Recurrence in pT2 was 0% in patients who had neoadjuvant therapy and 26% in the others. At univariate analysis, diameter, sm stage, pT stage, tumor grading, margin infiltration, and lymphovascular invasion demonstrated statistical significance. Multivariate analysis indicated sm stage, pT stage, and tumor grading as independent predictors of recurrence. Conclusions TEM represents an effective curative treatment for pT1 sm1 rectal malignancies. pT1 sm2-3 patients should be considered high-risk cases if treated only by TEM. A consistent improvement in the preoperative assessment of the risk factors identified by the present study will be a crucial development for optimal treatment of early rectal cancers.
Inadvertent perforation during rectal cancer resection in Norway
British Journal of Surgery, 2004
Background Inadvertent perforation of the bowel or tumour is a relatively common complication during resection of rectal cancer. The purpose of this study was to examine intraoperative perforation following the introduction of mesorectal excision as a standard surgical technique in Norway. Methods This was a prospective national cohort study of 2873 patients undergoing major resection of rectal carcinoma at 54 Norwegian hospitals from November 1993 to December 1999. Results The overall perforation rate was 8·1 per cent (234 of 2873 patients). In a multivariate analysis, the risk of perforation was significantly greater in patients undergoing abdominoperineal resection (odds ratio (OR) 5·6 (95 per cent confidence interval (c.i.) 3·5 to 8·8)) and in those aged 80 years or more (OR 2·0 (95 per cent c.i. 1·2 to 3·5)). The 5-year local recurrence rate was 28·8 per cent following perforation, compared with 9·9 per cent in patients with no perforation (P < 0·001); survival rates were 41...
Transanal Endoscopic Microsurgery for Rectal Neoplasms: Experience of 300 Consecutive Cases
Diseases of the Colon & Rectum, 2009
Background Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to transanal excision, enabling complete local excision of selected benign or malignant rectal tumors. This study aimed to determine the surgical and oncologic results for rectal tumors excised by TEM. Methods From November 2001 to October 2007, 45 patients underwent TEM for excision of adenoma (13 patients), carcinoid tumor (6 patients), and carcinoma (26 patients). The patients included 27 men and 18 women with a median age of 52 years (range, 22-72 years).
Colorectal Disease, 2009
The long-term results are presented on total survival, cancer-specific survival and recurrence in 143 consecutive patients treated with transanal endoscopic microsurgery (TEM) for adenocarcinoma of the rectum. Four Danish centres established in 1995 a database for registration of all TEM procedures. Data were supplemented from pathology reports and death certificates were checked in the Danish patient registry. Data were analysed with multivariance regression and survival analysis. The T stage was as follows: T1 50%, T2 33%, T3 14%, and stage unknown 3%. TEM was performed with curative intent in 43%, for compromise in 52% and for palliation in 5%. Five-year total survival was 66% and 5-year cancer-specific survival 87%. Cancer-specific survival for T1 was 94%. The significant predictors for total survival were age and tumour size. For cancer-specific survival T stage, radical resection, tumour size and recurrence were significant predictors. Eighteen per cent had recurrence and 15% had immediate reoperation. The TEM provides good long-term results for pT1 cancers. In old patients and patients with co-morbidity TEM may provide acceptable long-term results for T2 cancers. Tumours larger than 3 cm should not be treated with TEM for cure.
Outcomes of Transanal Endoscopic Microsurgery for T1 and T2 rectal cancer
Hellenic Journal of Surgery, 2010
The objective was to evaluate Transanal Endoscopic Microsurgery as a surgical strategy for stage I rectal cancer and its associated perioperative morbidity and oncologic outcomes. Methods: The present meta-analysis pooled the effects of outcomes of 986 patients enrolled in 3 randomized controlled trials, 1 prospective and 6 retrospective comparative studies. Results: The Meta-analysis revealed an advantage to Transanal Endoscopic Microsurgery over Standard Resection in lessening the number of patients presenting with major (O.R= 0,24 (0,07 -0,91) and overall postoperative complications (O.R= 0,16 (0,06 -0,38) and prolonging the disease-free survival (O.R= 0,46 (0,24 -0,88). On the contrary, Standard Resection was superior in terms of the number of patients with positive margins (O.R= 6,49 (1,49 -24,91), local recurrence (O.R= 4,92 (1,81 -13,41) and overall (local and distant recurrence: O.R= 2,03 (1,15 -3,57). No survival advantage was observed in favour of either procedure. The number of patients with positive margins was less in Transanal Endoscopic Microsurgery when compared to Transanal Excision whilst the reverse applied to the disease-free survival.
Outcomes for early rectal cancer managed with transanal endoscopic microsurgery
Surgical Endoscopy, 2006
Background: This study aimed to evaluate the long-term risk of local and distant recurrence as well as the survival of patients with early rectal cancer treated using transanal endoscopic microsurgery (TEM). Methods: The study reviewed 69 patients with T is /T 1 /T 2 rectal cancer treated using full-thickness excision between 1991 and 1999. The pathology T-stages included 25 T is , 23 T 1 , and 21 T 2 . The median follow-up period was 6.5 years (range 5-10.2 years). Results: The overall local recurrence rate was 8.7%. The 5-year local recurrence rate was 8% for T is , 8.6% for T 1 , and 9.5% for T 2 . All six patients with recurrence were managed surgically. The 5-year disease-specific survival rate was 100% for T is , 100% for T 1 , and 70% for T 2 . The overall cancer-related mortality rate was 7.2%. Conclusions: After local excision of early rectal cancer, a substantial local recurrence rate is observed. Patients with recurrent T is /T 1 cancers who undergo a salvage operation may achieve good long-term outcome. Local treatment without adjuvant therapy for T 2 rectal cancers appears inadequate.
Surgery may be curative for patients with a localized perforation of rectal carcinoma
British Journal of Surgery, 1999
Background Perforation at the time of operation adversely affects the prognosis of rectal cancer. These procedures have been termed ‘palliative’ or ‘non-curative’. The long-term outcome of generalized perforations may be different from that of localized or contained perforations. Although the oncological results may be compromised when the tumour is perforated, results in cases where the perforation is contained may not be as bad as previously thought. An attempt was made to examine the intermediate and long-term results for locally contained perforated rectal cancers. Methods Some 848 patients with rectal cancer were operated on between March 1989 and December 1995. Of these, 42 (5 per cent) had a locally contained perforation of the rectum. Median follow-up was 23 (range 12–74) months. Results The survival of patients with locally contained tumour perforation who underwent resection without macroscopic residual disease (40 per cent at 5 years) was significantly better than that of...