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Argenziano ME, Sorge A, Hoorens A, Montori M, Poortmans PJ, Smeets S, Tornai T, Debels LK, Desomer L, Tate DJ. Knife-assisted full-thickness resection guided by the pocket-detection method for posterior deeply invasive rectal cancer: A novel endoscopic approach (with video). DEN OPEN 2025; 5:e70116. [PMID: 40271449 PMCID: PMC12014851 DOI: 10.1002/deo2.70116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 03/25/2025] [Accepted: 04/06/2025] [Indexed: 04/25/2025]
Abstract
Local full-thickness resection techniques for rectal cancer are limited by lesion size, location, or poor margin delineation. We aimed to evaluate the feasibility of endoscopic knife-assisted full-thickness resection (kFTR) guided by the pocket-detection method (PDM) for deeply invasive rectal cancer. Consecutive posterior-lateral rectal lesions suspected of deep submucosal invasion treated at a tertiary care center from February to October 2024 were retrospectively included. kFTR guided by PDM involved creating a submucosal pocket to detect and isolate the suspected invasive component (muscle-retracting sign), followed by muscularis propria incision and full-thickness resection. Technical success, accuracy of detecting deep submucosal invasion, and en-bloc resection rates were 100%. The median procedure time was 141.5 [IQR 123.7-179.5] minutes and the median hospitalization was 1 [IQR 1-7] day. No adverse events occurred. Histopathology showed R1-vertical margin in patient 1 (pT2 adenocarcinoma) and R0 resection in patients 2, 3, and 4 (pT1bsm3) after refinement of the procedure to include a ≥3 mm muscularis propria margin around the suspected invasive component. There was no recurrence at the first endoscopic follow-up of patients 1, 2, and 4. Patient 3 was sent to surgical low anterior resection due to multiple high-risk histological features. The previous kFTR did not impair surgery (no residual rectal carcinoma and 1/17 positive lymph nodes). Endoscopic kFTR guided by the PDM may be a feasible organ-preserving treatment for the detection and resection of deeply invasive posterior rectal cancer. Future studies are needed to ascertain whether rectal kFTR could represent a viable alternative to conventional surgical local excision techniques.
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Affiliation(s)
- Maria Eva Argenziano
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
- Clinic of Gastroenterology, Hepatology and Emergency Digestive EndoscopyUniversità Politecnica delle MarcheAnconaItaly
| | - Andrea Sorge
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Anne Hoorens
- Department of PathologyUniversity Hospital of Ghent (UZ Ghent)GhentBelgium
| | - Michele Montori
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Clinic of Gastroenterology, Hepatology and Emergency Digestive EndoscopyUniversità Politecnica delle MarcheAnconaItaly
| | - Pieter Jan Poortmans
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
- Department of Gastroenterology & HepatologyUniversity Hospital Brussels (UZ Brussels)BrusselsBelgium
| | - Sander Smeets
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
| | - Tamas Tornai
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
| | - Lynn K. Debels
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
- Department of Gastroenterology & HepatologyUniversity Hospital Brussels (UZ Brussels)BrusselsBelgium
| | - Lobke Desomer
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Department of Gastroenterology & HepatologyRoeselareBelgium
| | - David J. Tate
- Department of Gastroenterology & HepatologyUniversity Hospital Ghent (UZ Ghent)GhentBelgium
- Faculty of Medicine and Health SciencesUniversity of GhentGhentBelgium
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Baik H. Minimally invasive transanal excision over conventional transanal excision: pursuing the perfect removal of early rectal cancer. Ann Coloproctol 2025; 41:105-106. [PMID: 40313125 PMCID: PMC12046407 DOI: 10.3393/ac.2025.00479.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2025] [Accepted: 04/15/2025] [Indexed: 05/03/2025] Open
Affiliation(s)
- HyungJoo Baik
- Division of Colorectal Surgery, Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Mun JY, Geong GS, Yoo N, Kim HJ, Cho HM, Kye BH. Minimally invasive transanal excision for rectal tumors: technical feasibility compared to conventional approach. Ann Coloproctol 2025; 41:162-168. [PMID: 40313130 PMCID: PMC12046413 DOI: 10.3393/ac.2024.00864.0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Revised: 01/12/2025] [Accepted: 01/19/2025] [Indexed: 05/03/2025] Open
Abstract
PURPOSE The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited. METHODS Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups. RESULTS There were no significant differences observed in patient's demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation. CONCLUSION The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.
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Affiliation(s)
- Ji Yeon Mun
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Gyu Sung Geong
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Nina Yoo
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Li X, Guo S, Yao K, Ge Z, Li Y, Hu J, Xia H. Learning curve of transanal minimally invasive surgery for rectal neoplasm. Front Oncol 2025; 15:1545589. [PMID: 40201352 PMCID: PMC11975934 DOI: 10.3389/fonc.2025.1545589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2024] [Accepted: 03/10/2025] [Indexed: 04/10/2025] Open
Abstract
Objectives The field of view through transanal endoscopic provides new treatment approaches for solving complex clinical problems. TAMIS belongs to single-port endoscopic surgery, and the operation is complex. Analyzing the learning curve of TAMIS aims to facilitate its better clinical promotion. Methods A retrospective cohort study analyzed the clinical data of 58 patients who underwent TAMIS by the same surgeon from January 2018 to October 2024. The learning curve of TAMIS was obtained using the cumulative sum (CUSUM) analysis, and the optimal number of surgeries was determined based on the peak value of the curve, Clinical indicators such as operative time, intraoperative blood loss, positive rate of circumferential margin, length of postoperative hospital stay, and incidence of postoperative complications were compared at different stages. Results All 58 patients successfully underwent TAMIS. The optimum curve equation was y=0.016x 3-2.0556x 2+67.240x-150.103, R 2 = 0.950, P<0.05. According to the peak value of the curve, 22 cases were determined as the minimum cumulative required cases for surgeons to cross the TAMIS learning curve. 58 cases were divided into two groups: the learning improvement group (Pre-proficiency) of the first 22 cases, and the proficiency group (Post-proficiency) of the latter 36 cases. Compared with Pre-proficiency stage, the Post-proficiency stage had shorter surgery duration, less intraoperative blood loss, and shorter length of postoperative hospital stay (P<0.05). There was no statistically significant difference in the observation indicators including positive rate of circumferential margin and incidence of postoperative complications between the two groups (P>0.05). Conclusions The learning curve of TAMIS can be divided into Pre-proficiency stage and Post-proficiency stage. 22 surgeries may be the number of surgeries required to cross the TAMIS learning curve.
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Affiliation(s)
- Xingwang Li
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
- Department of General Surgery, Huaihe Hospital Affiliated to Henan University, Henan, China
| | - Shaoqing Guo
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
| | - Kunhou Yao
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
| | - Zheng Ge
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
- Department of General Surgery, Huaihe Hospital Affiliated to Henan University, Henan, China
| | - Yuewei Li
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
| | - Junhong Hu
- Department of Colorectal and Anal Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Hongping Xia
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
- Department of General Surgery, Huaihe Hospital Affiliated to Henan University, Henan, China
- Zhongda Hospital, School of Medicine, Advanced Institute for Life and Health, Southeast University, Jiangsu, China
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Khalifa M, Gingold-Belfer R, Issa N. Local Recurrence of Premalignant and Early Malignant Rectal Polyps Treated by TEM-A Single-Center Experience. J Clin Med 2024; 14:80. [PMID: 39797162 PMCID: PMC11721902 DOI: 10.3390/jcm14010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 12/22/2024] [Accepted: 12/25/2024] [Indexed: 01/13/2025] Open
Abstract
Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive approach for excising rectal polyps, particularly those with high-grade dysplasia (HGD) or early-stage rectal cancer (T1). This study aimed to evaluate the recurrence risk and its associated factors in patients treated with TEM for HGD and T1 rectal tumors. Methods: A retrospective review was conducted on 79 patients who underwent TEM for rectal lesions at Rabin Medical Center-Hasharon Hospital from 2005 to 2019. Data collected included demographics, tumor characteristics, and follow-up outcomes, with specific focus on tumor size, resection margins, mucin production, and distance from anal verge (AV). Separate and unified analyses were performed to assess the recurrence risk factors for both HGD and T1 patients. Results: Sixty-three patients were included in the final analysis. In the unified analysis, larger tumor size was significantly associated with increased recurrence risk (OR = 2.27, p = 0.028), and mucin production was a strong predictor of recurrence in the T1 group and combined analysis (p = 0.0012 and p = 0.014, respectively). Distance from AV demonstrated a borderline association with recurrence (p = 0.053). Conclusions: Larger tumor size and mucin production are significant predictors of recurrence in TEM-treated rectal polyps. Personalized follow-up and postoperative management are essential for patients with these risk factors to reduce the recurrence risk.
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Affiliation(s)
- Muhammad Khalifa
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel;
| | - Rachel Gingold-Belfer
- Department Gastroenterology, Rabin Medical Center-Hasharon Hospital, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel;
| | - Nidal Issa
- Department of Surgery, Rabin Medical Center-Hasharon Hospital, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel;
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Garoufalia Z, Rogers P, Meknarit S, Mavrantonis S, Aeschbacher P, Ray-Offor E, Emile SH, Gefen R, Dourado J, Horesh N, Wexner SD. Trans‑anal minimally invasive surgery (TAMIS) versus rigid platforms for local excision of early rectal cancer: a systematic review and meta-analysis of the literature. Surg Endosc 2024; 38:4198-4206. [PMID: 39026004 PMCID: PMC11289048 DOI: 10.1007/s00464-024-11065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Available platforms for local excision (LE) of early rectal cancer are rigid or flexible [trans‑anal minimally invasive surgery (TAMIS)]. We systematically searched the literature to compare outcomes between platforms. METHODS PRISMA-compliant search of PubMed and Scopus databases until September 2022 was undertaken in this random-effect meta-analysis. Statistical heterogeneity was assessed using I2 statistic. Studies comparing TAMIS versus rigid platforms for LE for early rectal cancer were included. Main outcome measures were intraoperative and short-term postoperative outcomes and specimen quality. RESULTS 7 studies were published between 2015 and 2022, including 931 patients (423 females); 402 underwent TAMIS and 529 underwent LE with rigid platforms. Techniques were similar for operative time (WMD 11.1, 95%CI - 2.6 to 25, p = 0.11), percentage of defect closure (OR 0.7, 95%CI 0.06-8.22, p = 0.78), and peritoneal violation (OR 0.41, 95%CI 0.12-1.43, p = 0.16). Rigid platforms had higher rates of short-term complications (19.1% vs 14.2, OR 1.6, 95%CI 1.07-2.4, p = 0.02), although no significant differences were seen for major complications (OR 1.41, 95%CI 0.61-3.23, p = 0.41). Patients in the rigid platforms group were 3-times more likely to be re-admitted within 30 days compared to the TAMIS group (OR 3.1, 95%CI 1.07-9.4, p = 0.03). Rates of positive resection margins (rigid platforms: 7.6% vs TAMIS: 9.34%, OR 0.81, 95%CI 0.42-1.55, p = 0.53) and specimen fragmentation (rigid platforms: 3.3% vs TAMIS: 4.4%, OR 0.74, 95%CI 0.33-1.64, p = 0.46) were similar between the groups. Salvage surgery was required in 5.5% of rigid platform patients and 6.2% of TAMIS patients (OR 0.8, 95%CI 0.4-1.8, p = 0.7). CONCLUSION TAMIS or rigid platforms for LE seem to have similar operative outcomes and specimen quality. The TAMIS group demonstrated lower readmission and overall complication rates but did not significantly differ for major complications. The choice of platform should be based on availability, cost, and surgeon's preference.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | | | | | - Pauline Aeschbacher
- Department of General Surgery and Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA
- Department for Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
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Jiang SX, Zarrin A, Shahidi N. T1 colorectal cancer management in the era of minimally invasive endoscopic resection. World J Gastrointest Oncol 2024; 16:2284-2294. [PMID: 38994167 PMCID: PMC11236244 DOI: 10.4251/wjgo.v16.i6.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
T1 colorectal cancer (CRC), defined by tumor invasion confined to the submucosa, has historically been managed by surgery. Improved understanding of recurrence and lymph node metastases risk, coupled with advances in endoscopic resection techniques, have led to an increasing capacity for organ-sparing local excision. Minimally invasive management of T1 CRC begins with optical evaluation of the lesion to diagnose invasive disease and quantify depth of invasion, which informs therapeutic decision making. Modality selection between various available endoscopic resection techniques depends upon lesion characteristics, technique risk-benefit profiles, and location-specific implications. Following endoscopic resection, established histopathology features determine the risk of recurrence and subsequent management including surveillance or adjuvant surgical excision. The management of non-operative candidates deviates from conventional recommendations with emerging treatment strategies in select populations.
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Affiliation(s)
- Shirley Xue Jiang
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
| | - Aein Zarrin
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
| | - Neal Shahidi
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
- Division of Gastroenterology, St. Paul’s Hospital, Vancouver V6Z2K5, British Columbia, Canada
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Binda C, Secco M, Tuccillo L, Coluccio C, Liverani E, Jung CFM, Fabbri C, Gibiino G. Early Rectal Cancer and Local Excision: A Narrative Review. J Clin Med 2024; 13:2292. [PMID: 38673565 PMCID: PMC11051053 DOI: 10.3390/jcm13082292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of the large intestine, is a fertile ground for local excision techniques performed with endoscopic or surgical techniques. Moreover, the advancement in endoscopic optical evaluation and the better definition of imaging techniques allow for a more precise local staging of early rectal cancer. Although the local treatment of early rectal cancer seems promising, in clinical practice, a significant number of patients who could benefit from local excision techniques undergo total mesorectal excision (TME) as the first approach. All relevant prospective clinical trials were identified through a computer-assisted search of the PubMed, EMBASE, and Medline databases until January 2024. This review is dedicated to endoscopic and surgical local excision in the treatment of early rectal cancer and highlights its possible role in current and future clinical practice, taking into account surgical completion techniques and chemoradiotherapy.
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Affiliation(s)
| | | | | | | | | | | | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy; (C.B.); (M.S.); (L.T.); (C.C.); (E.L.); (C.F.M.J.); (G.G.)
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Šemanjski K, Lužaić K, Brkić J. Current Surgical Methods in Local Rectal Excision. Gastrointest Tumors 2023; 10:44-56. [PMID: 39015761 PMCID: PMC11249472 DOI: 10.1159/000538958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/10/2024] [Indexed: 07/18/2024] Open
Abstract
Background The treatment of rectal cancer has evolved with the advancement of surgical techniques. Less invasive approaches are becoming more accepted as the primary treatment method. Summary Such methods as transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery can reduce morbidity and mortality rates. However, not all patients are suitable candidates for these procedures, and proper diagnostics are necessary to establish indications. Compared to total mesorectal excision, transanal excision techniques have been shown to have fewer complications and comorbidities while still being able to remove cancerous tissue entirely. Transanal excision is the simplest method, where the operator removes visible rectal lesions. The basic principle of transanal endoscopic microsurgery is to dilate the rectum mechanically and by air insufflation and then use special surgical instruments to remove suspicious lesions under the vision of a telescope. Transanal minimally invasive surgery combines transanal endoscopic microsurgery and single-incision laparoscopic surgery, making the hard-to-reach proximal rectum accessible to classic laparoscopic instruments. Key Message Local excision techniques, when used as a monotherapy for treating patients with rectal cancer, have established themselves as a curative and less radical treatment for strictly selected patients with early rectal carcinoma, leading to improved quality of life. When combined with other modalities such as neoadjuvant chemoradiotherapy, total neoadjuvant therapy, and immunotherapy, transanal surgery can be offered to patients with locally advanced rectal cancer as part of the organ preservation strategy. This review will discuss the patient selection and technical aspects of transanal surgery, showcasing its current role in treating rectal carcinoma.
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Affiliation(s)
| | - Karla Lužaić
- Institute of Emergency Medicine of Sisak - Moslavina County, Sisak, Croatia
| | - Jure Brkić
- Department of Surgery, Clinical Hospital Sveti Duh, Zagreb, Croatia
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MRI-based radiomics to predict neoadjuvant chemoradiotherapy outcomes in locally advanced rectal cancer: A multicenter study. Clin Transl Radiat Oncol 2022; 38:175-182. [DOI: 10.1016/j.ctro.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
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Endoscopic full-thickness dissection (EFTD) in the rectum: a case series. Tech Coloproctol 2021; 26:187-193. [PMID: 34964075 PMCID: PMC8857165 DOI: 10.1007/s10151-021-02558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/29/2021] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Rectal endoscopic full- thickness dissection (EFTD) using a flexible colonoscope is an alternative to the well-established trans-anal endoscopic microsurgery (TEM) and the trans-anal minimally invasive surgery (TAMIS) techniques for resecting dysplastic or malignant rectal lesions. This study evaluated EFTD safety by analyzing outcomes of the first patients to undergo rectal EFTD at the University Hospital of North-Norway.
Methods
The first 10 patients to undergo rectal EFTD at the University Hospital of North-Norway April, 2016 and January, 2021, were included in the study. The procedural indications for EFTD were therapeutic resection of non-lifting adenoma, T1 adenocarcinoma (AC), recurrent neuroendocrine tumor (NET) and re-excision of a T1-2 AC.
Results
EFTD rectal specimen histopathology revealed three ACs, five adenomas with high-grade dysplasia (HGD), one NET and one benign lesion. Six procedures had negative lateral and vertical resection margins and in three cases lateral margins could not be evaluated due to piece-meal dissection or heat damaged tissue. Two patients experienced delayed post-procedural hemorrhage, one of whom also presented with a concurrent post-procedural infection. No serious complications occurred.
Conclusion
Preliminary results from this introductory trial indicate that EFTD in the rectum can be conducted with satisfactory perioperative results and low risk of serious complications.
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Rudiman R. Minimally invasive gastrointestinal surgery: From past to the future. Ann Med Surg (Lond) 2021; 71:102922. [PMID: 34703585 PMCID: PMC8521242 DOI: 10.1016/j.amsu.2021.102922] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 12/21/2022] Open
Abstract
The improvement of the science and art of surgery began over 150 years ago. Surgical core tasks, “cutting and sewing” with hand and direct contact with the organs, have remained the same. However, in the 21st century, there has been a shifting paradigm in the methodology of surgery. The joint union between innovators, engineers, industry, and patient demands resulted in minimally invasive surgery (MIS). This method has influenced the techniques in every aspect of abdominal surgery, such as surgeons are not required to direct contact or see the structures on which they operate. Advances in the endoscope, imaging, and improved instrumentations convert the essential open surgery into the endoscopic method. Furthermore, computers and robotics show a promising future to facilitate complex procedures, enhance accuracy in microscale operations, and develop a simulation to improve the ability to face sophisticated approaches. MIS has been replacing open surgery due to improved survival, fewer complications, and rapid recoveries in recent years. Minimally invasive surgery's further research in diagnostic and therapeutic modalities is under investigation to achieve genuinely “noninvasive” surgery. Thus, MIS has gained interest in recent days and has been improving with promising outcomes.
Minimally invasive surgery has interfered with multiple aspects of the surgical approach. Advancement in the endoscope, imaging, and other instrumentations shifting the current methodological conventional surgery. The benefit over risk is the promising primary outcome to achieve an exceptional quality of life.
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Affiliation(s)
- Reno Rudiman
- Digestive Surgeon, Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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