Abstract
Background: This study describes a personal experience with the use of transanal endoscopic microsurgery to facilitate surgical access, and to determine the ability of this technique to reduce the need for major abdominal procedure and prevent the need for a temporary or permanent colostomy in select patients with known or suspected rectal cancer. Methods: The subjects of this study were 43 patients with rectal cancer or tumors who had a high likelihood of malignancy. The 24 men and 19 women comprised two groups: patients with known cancer (n = 16) and patients with tumors suspicious for cancer (n = 27), six of whom proved to have invasive malignancy. The tumors ranged in size from 1 to 7 cm (average, 3.5 cm). The tumor’s inferior level in the rectum ranged from −1 to 21 cm (average, 6.5 cm). Eleven patients known to have rectal cancer were treated with preoperative radiation or chemoradiation. By ordinary standards, 22 patients would have received an abdominal perineal resection; 14 patients would have qualified for abdominal sphincter–preserving operations; and 7 patients were indeterminate. Full-thickness local excisions were disk excisions (n = 23), hemicircumferential excisions (n = 19), and sleeve resection (n = 1). The ages of the patients ranged from 30 to 91 years (average, 66.7 years). Results: In this study, 90% avoided a major abdominal operation (39/43), and 90% avoided an abdominal perineal resection of the patients (20/22). The complications were as follows: mortality (n = 10), morbidity (n = 9), minor wound separation (n = 6), and major wound separation (n = 3). Two of these complications were rectovaginal fistulas: the one in a 91-year-old patient who presented with a fistula and the other in a 77-year-old patient who presented with a previously irradiated and incompletely excised cancer. A single instance of locally recurrent cancer required an abdominal perineal resection. There were no other recurrences. Overall, three patients required a stoma (7%). Conclusion: Transanal endoscopic microsurgery promises to offer a safe and effective option for the selective treatment of patients with rectal cancer after preoperative chemoirradiation, and for the management of tumors suspicious for rectal cancer. Transanal endoscopic microsurgery used selectively can reduce the need for major abdominal surgery and colostomy.
Similar content being viewed by others
References
G Buess F Hutterer J Theiss M Bobel W Isselhard H Pichlmaier (1986) ArticleTitleA system for a transanal endoscopic rectum operation. Chirurg 55 677–680
G Buess B Mentges K Manncke M Starlinger HD Becker (1992) ArticleTitleTechnique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg 163 63–69 Occurrence Handle1:STN:280:By2C38rmt1E%3D Occurrence Handle1733375
A Habr-Gama PM de Souza U Ribeiro Jr W Nadalin R Gansl AH Sousa Jr FG Campos J Gama-Rodrigues (1998) ArticleTitleLow rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon Rectum 41 1087–1096 Occurrence Handle1:STN:280:DyaK1cvhvF2hsg%3D%3D Occurrence Handle9749491
DM Hyams EP Mamounas N Petrelli H Rockette J Jones HS Wieand M Deutsch L Wickerham B Fisher N Wolmark (1997) ArticleTitleA clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum: a progress report of National Surgical Breast and Bowel Project Protocol R-03. Dis Colon Rectum 40 131–139 Occurrence Handle1:STN:280:ByiB3s%2Fhs1M%3D Occurrence Handle9075745
InstitutionalAuthorName Swedish Rectal Cancer Trial (1997) ArticleTitleImproved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336 980–987 Occurrence Handle10.1056/NEJM199704033361402 Occurrence Handle9091798
NA Janjan CN Crane BW Feig K Cleary R Dubrow SA Curley LM Ellis J Vauthey R Lenzi P Lynch R Wolff T Brown R Pazdur J Abbruzzese PM Hoff P Alien B Brown J Skibber (2000) ArticleTitleProspective trial of preoperative concomitant boosts radiotherapy with continuous infusion 5-fluorouracil for locally advanced rectal cancer. Int J Radiat Oncol Biol Phys 47 713–718 Occurrence Handle10.1016/S0360-3016(00)00418-1 Occurrence Handle1:STN:280:DC%2BD3c3pvVOjtg%3D%3D Occurrence Handle10837955
M Killingback (1992) ArticleTitleLocal excision of carcinoma of the rectum: indications. World J Surg 16 437–446 Occurrence Handle1:STN:280:By2B2s7lt1A%3D Occurrence Handle1317077
E Lezoche M Guerrieri AM Paganini F Feliciotti (1998) ArticleTitleTransanal endoscopic microsurgical excision of irradiated and nonirradiated rectal cancer. a 5-year experience. Surg Laparosc Endosc 8 249–256 Occurrence Handle10.1097/00019509-199808000-00001 Occurrence Handle1:STN:280:DyaK1czmvFaitQ%3D%3D Occurrence Handle9703594
G Marks MM Mohiuddin L Masoni L Pecchioli (1990) ArticleTitleHigh-dose preoperative radiation and full-thickness local excision: a new option for patients with select cancers of the rectum. Dis Colon Rectum 33 735–739 Occurrence Handle1:STN:280:By%2BA28%2FnsFA%3D Occurrence Handle2390908
J Mayer NJ Mortensen (1995) ArticleTitleTransanal endoscopic microsurgery: a forgotten minimally invasive operation. Br J Surg 82 435–437 Occurrence Handle1:STN:280:ByqA3sfmtFI%3D Occurrence Handle7613882
A Mellgren P Sirivongs DA Rothenberger RD Madoff J Garcia-Aguilar (2000) ArticleTitleIs local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43 1064–1071
M Morschel A Heintz M Bussmann T Junginger (1998) ArticleTitleFollow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps. Langenbecks Arch Surg 383 320–324 Occurrence Handle10.1007/s004230050140 Occurrence Handle1:STN:280:DyaK1M%2FnsFGltA%3D%3D Occurrence Handle9860223
LE Smith ST Ko T Saclarides P Caushaj BA Orkin KS Khanduja (1996) ArticleTitleTransanal endoscopic microsurgery: initial registry results. Dis Colon Rectum IssueID10 Suppl S79–84
G Steele J Herndon R Bleday A Russell A Benson III M Hussain A Burgess J Tepper R Mayer (1999) ArticleTitleSphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 6 433–441 Occurrence Handle10458680
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Marks, J., Marchionni, C. & Marks, G. Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer . Surg Endosc 17, 1114–1117 (2003). https://doi.org/10.1007/s00464-002-8873-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-002-8873-z