Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer

doi:10.4251/wjgo.v16.i3.933

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World Journal of Gastrointestinal Oncology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Clinical and Translational Research

World J Gastrointest Oncol. Mar 15, 2024; 16(3): 933-944
Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.933

Clinical efficacy and pathological outcomes of transanal endoscopic intersphincteric resection for low rectal cancer

Zhi-Wen Xu, Jing-Tao Zhu, Hao-Yu Bai, Xue-Jun Yu, Qing-Qi Hong, Jun You

Zhi-Wen Xu, Jing-Tao Zhu, Hao-Yu Bai, Xue-Jun Yu, Qing-Qi Hong, Jun You, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, Fujian Province, China

Author contributions: You J and Hong QQ designed the research; Xu ZW performed the research; Zhu JT and Bai HY contributed new reagents or analytic tools; Xu ZW and Yu XJ analyzed the data; Xu ZW wrote the paper.

Institutional review board statement: The study was reviewed and approved by the institutional review boards of First Affiliated Hospital of Xiamen University.

Informed consent statement: Patient consent was waived due to the retrospective character of the study, and it was approved by the Ethics Committee at the First Affiliated Hospital of Xiamen University. All procedures performed in studies involving human participants were conducted according to the ethical standards of the institutional research committee and the Helsinki declaration and later revision.

Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Jun You, PhD, Professor, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No. 55 Zhenhai Road, Xiamen 361000, Fujian Province, China. youjun@xmu.edu.cn

Received: August 18, 2023
Peer-review started: August 18, 2023
First decision: October 23, 2023
Revised: November 5, 2023
Accepted: December 29, 2023
Article in press: December 29, 2023
Published online: March 15, 2024
Processing time: 206 Days and 23.8 Hours

Abstract

BACKGROUND

Transanal endoscopic intersphincteric resection (ISR) surgery currently lacks sufficient clinical research and reporting.

AIM

To investigate the clinical effectiveness of transanal endoscopic ISR, in order to promote the clinical application and development of this technique.

METHODS

This study utilized a retrospective case series design. Clinical and pathological data of patients with lower rectal cancer who underwent transanal endoscopic ISR at the First Affiliated Hospital of Xiamen University between May 2018 and May 2023 were included. All patients underwent transanal endoscopic ISR as the surgical approach. We conducted this study to determine the perioperative recovery status, postoperative complications, and pathological specimen characteristics of this group of patients.

RESULTS

This study included 45 eligible patients, with no perioperative mortalities. The overall incidence of early complications was 22.22%, with a rate of 4.44% for Clavien-Dindo grade ≥ III events. Two patients (4.4%) developed anastomotic leakage after surgery, including one case of grade A and one case of grade B. Postoperative pathological examination confirmed negative circumferential resection margins and distal resection margins in all patients. The mean distance between the tumor lower margin and distal resection margin was found to be 2.30 ± 0.62 cm. The transanal endoscopic ISR procedure consistently yielded high quality pathological specimens.

CONCLUSION

Transanal endoscopic ISR is safe, feasible, and provides a clear anatomical view. It is associated with a low incidence of postoperative complications and favorable pathological outcomes, making it worth further research and application.

Keywords: Intersphincteric resection; Transanal; Rectal cancer; Complications; Endoscopic

Core Tip: In recent years, our center has conducted extensive research and accumulated experience in transanal endoscopic intersphincteric resection (ISR) procedures. In this study, we present the surgical outcomes, perioperative complications, and pathological findings based on the transanal endoscopic ISR surgeries performed in our center to contribute to the clinical application and development of this technique.