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

  title={Risk of complications and long-term functional alterations after local excision of rectal tumors with transanal endoscopic microsurgery (TEM)},
  author={Angelo Restivo and Luigi Zorcolo and Giuseppe D’Alia and Francesca Cocco and Andrea Pasquale Cossu and Francesco Scintu and Giuseppe Casula},
  journal={International Journal of Colorectal Disease},
IntroductionTransanal 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.MethodsWe prospectively recorded the clinical data of 157 patients who underwent TEM from 1996 to 2013. Among these, 89… 

Short-term clinical and functional results of rectal wall suture defect after transanal endoscopic microsurgery—a prospective cohort study

It is suggested that 1/3 of the patients’ rectal wall defect after TEM will undergo dehiscence in early postoperative period and will not transfer to clinically significant manifestation (without a need of hospitalization or prolonging it) and in late postoperatively period, there is no difference in bowel function.

Transanal minimally invasive surgery for rectal polyps and selected malignant tumors: caution concerning intermediate-term functional results

The incidence of impaired fecal continence after TAMIS is substantial; however, the clinical significance of this deterioration seems minor; the present data is helpful in acquiring informed consent and emphasizes the need of proper patient information.

Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program

The low rates of morbidity, re-hospitalization, and postoperative complications in the first 2 days after surgery make the procedure suitable for A-OdS, according to an observational study of consecutive patients undergoing TEM.

Current Trends on the Status of Transanal Endoscopic Microsurgery

Patients undergoing TES report significantly lower rates of postoperative complications and better functional outcomes than patients who receive abdominal rectal resection with total mesorectal excision, with no adverse impact on long-term survival.

Transanal endoscopic microsurgery for advanced polyps and early cancers in the rectum—Long-term outcome

TEM seems to be a safe and viable procedure for removing both benign and malignant lesions from the rectum and TEM offers low mortality and complication rates also recurrence after resection of malignant tumors.

Should the rectal defect be sutured following TEMS/TAMIS carried out for neoplastic rectal lesions? A Meta-Analysis.

Suturing the rectal defect following excision of rectal neoplasm by TEMS/TAMIS reduces the incidence of postoperative bleeding in comparison to leaving the defect open, however, suturing makes the procedure slightly longer but there was no statistical difference between both groups when postoperative infection and length of hospital stay were compared.

Management of intra- and postoperative complications during TEM/TAMIS procedures: a systematic review

A review of the most important TEM series and their complication rates and describe various approaches to their management is presented.

Fecal incontinence after transanal endoscopic microsurgery

Fecal incontinence after TEM is more common than thought previously, resulting in significantly impaired quality of life and older age at the time of operation was an independent risk factor for developing significant fecalincontinence.

Completion surgery vs. primary TME for early rectal cancer: a national study

There was no difference in overall survival, disease-free survival, local and distant recurrence, and the rate of R0 resection at completion surgery in the CS and pTME groups, and oncological results were similar in the two groups.

Should the rectal defect be closed following transanal local excision of rectal tumors? A systematic review and meta-analysis

It is suggested that there is no difference between closure or non-closure of wall defects after TLE, as shown in a systematic review and meta-analysis of relevant studies.



Complications after transanal endoscopic microsurgical resection correlate with location of rectal neoplasms

The learning curve for transanal endoscopic microsurgery appears to be negligible in surgeons with experience in minimal invasive surgery, and resection of neoplasms located on the lateral rectal wall have a higher risk of bleeding.

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

TEM represents an effective curative treatment for pT1 sm1 rectal malignancies and should be considered high-risk cases if treated only by TEM, and a consistent improvement in the preoperative assessment of the risk factors identified will be a crucial development for optimal treatment of early rectal cancers.

Transanal endoscopic microsurgery in treatment of rectal adenomas and T1 low-risk carcinomas

The high efficacy of transanal endoscopic microsurgery ensures minimally invasive treatment of adenomas and low-risk T1 carcinomas with low complication rates and a low rate of therapeutic failure.

Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery?

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, and the use of TEM to resect rectal lesions involving the intraperitoneal rectum may represent an intermediate step toward the development of transrectal natural orifice translumenal endoscopic surgery (NOTES) techniques.

Treatment of Recurrence After Transanal Endoscopic Microsurgery (TEM) for T1 Rectal Cancer

Although salvage surgery for achieving local control is feasible in most patients, survival is limited, mainly because of distant metastases, and Tailoring selection of T1 rectal cancers and exploring possible adjuvant treatment strategies following salvage procedures should be the next steps toward improving survival.

Impact of transanal endoscopic microsurgery on functional outcome and quality of life

This study indicates TEM has no deteriorating effect on faecal continence and once the tumour has been excised using TEM, quality of life is improved.

Transanal Endoscopic Microsurgery: A Prospective Evaluation of Functional Results

PURPOSELocal excision is a commonly used technique for many benign and selected malignant rectal lesions. Compared with radical resection, it is associated with decreased morbidity and mortality and

Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome

TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery, and preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1  year from surgery.

Treatment of rectal cancer by transanal endoscopic microsurgery: experience with 425 patients.

TEM is a safe and effective procedure to treat rectal cancer in selected patients without evidence of nodal involvement and cancer-specific survival rates at the end of follow-up were 100% for pT1 patients (253 mo), 93% for t2 patients (255 mo) and 89% forpT3 patients (239 mo).