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Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indications among 168 consecutive patients
Author(s) -
Saget A.,
Maggiori L.,
Petruciani N.,
Ferron M.,
Panis Y.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13000
Subject(s) - medicine , surgery , perforation , anal stenosis , hemorrhoids , materials science , punching , metallurgy
Abstract Aim To assess the surgical outcome of transanal endoscopic surgery (TES) for rectal neoplasms in technically challenging indications. Method All patients who underwent TES for a rectal neoplasm from 2007 to 2014 were included. Technically challenging indications included a tumour with (i) diameter ≥ 5 cm, (ii) involving ≥ 50% of the rectal circumference and (iii) located ≥ 10 cm from the anal verge. Patients were divided into three groups according to how many of these features they had, as follows: Group 1, none; Group 2, one; Group 3, two or more. Results Of the 168 patients (80 benign and 88 malignant tumours) included in the study, 73 (44%) were in Group 1, 46 (27%) in Group 2 and 49 (29%) in Group 3. There was no difference between Group 1 and Group 2 with regard to peritoneal perforation ( P = 0.210), severe postoperative morbidity ( P = 0.804), length of hospital stay ( P = 0.444), incomplete resection ( P = 0.441), piecemeal resection ( P = 0.740), locoregional recurrence ( P = 0.307) and long‐term symptomatic rectal stenosis ( P = 0.076). Conversely Group 3 showed significantly impaired results compared with Group 1 with regard to peritoneal perforation ( P = 0.003), piecemeal resection ( P = 0.005), incomplete resection ( P = 0.025), locoregional recurrence ( P = 0.035) and long‐term symptomatic rectal stenosis ( P < 0.001), but no difference in severe postoperative morbidity ( P = 0.328). Conclusion Transanal endoscopic surgery for rectal neoplasms appears to be safe and effective, even in patients presenting with a technically challenging tumours. Although the short‐ and long‐term outcomes after TES are worse in patients with highly challenging tumours, nevertheless the technique should still be considered in patients at high risk of requiring a proctectomy.