6 results on '"Transanal Endoscopic Microsurgery methods"'
Search Results
2. Safe and Effective Endoscopic Resection of Massive Colorectal Adenomas ≥8 cm in a Tertiary Referral Center.
- Author
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Emmanuel A, Gulati S, Burt M, Hayee B, and Haji A
- Subjects
- Female, Humans, London epidemiology, Male, Middle Aged, Patient Selection, Tertiary Care Centers statistics & numerical data, Transanal Endoscopic Microsurgery adverse effects, Transanal Endoscopic Microsurgery methods, Treatment Outcome, Tumor Burden, Adenoma epidemiology, Adenoma pathology, Adenoma surgery, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Endoscopic Mucosal Resection adverse effects, Endoscopic Mucosal Resection methods, Neoplasm Recurrence, Local pathology, Postoperative Hemorrhage diagnosis, Postoperative Hemorrhage etiology
- Abstract
Background: Endoscopic resection of large colorectal lesions is well reported and is the first line of treatment for all noninvasive colorectal neoplasms in many centers, but little is known about the outcomes of endoscopic resection of truly massive colorectal lesions ≥8 cm., Objective: We report on the outcomes of endoscopic resection for massive (≥8 cm) colorectal adenomas and compare the outcomes with resection of large (2.0-7.9 cm) lesions., Design: This was a retrospective study., Settings: The study was conducted in a tertiary referral unit for interventional endoscopy., Patients: A total of 435 endoscopic resections of large colorectal polyps (≥2 cm) were included, of which 96 were ≥8 cm., Main Outcome Measures: Outcomes included initial successful resection, complications, recurrence, surgery, and hospital admission., Results: Endoscopic resection was successful for 91 of 96 massive lesions (≥8 cm). Mean size was 10.1 cm (range, 8-16 cm). A total of 75% had previous attempts at resection or heavy manipulation before referral. Thirty two were resected using endoscopic submucosal dissection or hybrid endoscopic submucosal dissection and the rest using piecemeal endoscopic mucosal resection. No patients required surgery for a perforation. Five patients had postprocedural bleeding. There were 25 recurrences: 2 were treated with transanal endoscopic microsurgery, 2 with right hemicolectomy, and the rest with endoscopic resection. Compared with patients with large lesions, more patients with massive adenomas had complications (19.8% versus 3.3%), required admission (39.6% versus 11.0%), developed recurrence (30.8% versus 9.9%), or required surgery for recurrence (5.0% versus 0.8%)., Limitations: This was a retrospective study., Conclusions: Endoscopic resection of massive colorectal adenomas ≥8 cm is achievable with few significant complications, and the majority of patients avoid surgery. Systematic assessment is required to appropriately select patients for endoscopic resection, which should be performed in specialist units. See Video Abstract at http://links.lww.com/DCR/A653.
- Published
- 2018
- Full Text
- View/download PDF
3. Outcomes of Closed Versus Open Defects After Local Excision of Rectal Neoplasms: A Multi-institutional Matched Analysis.
- Author
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Lee L, Althoff A, Edwards K, Albert MR, Atallah SB, Hunter IA, Hill J, and Monson JRT
- Subjects
- Aged, Female, Humans, Incidence, Male, Margins of Excision, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Operative Time, Postoperative Complications epidemiology, Propensity Score, Rectal Neoplasms epidemiology, Rectal Neoplasms pathology, Rectum pathology, Transanal Endoscopic Microsurgery adverse effects, Transanal Endoscopic Microsurgery methods, Treatment Outcome, Wound Closure Techniques, Rectal Neoplasms surgery, Rectum abnormalities, Rectum surgery, Transanal Endoscopic Surgery methods
- Abstract
Background: The management of the rectal wall defect after local excision of rectal neoplasms remains controversial, and the existing data are equivocal., Objective: This study aimed to determine the effect of open versus closed defects on postoperative outcomes after local excision of rectal neoplasms., Design: Data from 3 institutions were analyzed. Propensity score matching was performed in one-to-one fashion to create a balanced cohort comparing open and closed defects., Settings: This study was conducted at high-volume specialist referral hospitals., Patients: Adult patients undergoing local excision via transanal endoscopic surgery from 2004 to 2016 were included. Patients were assigned to open- and closed-defect groups, and further stratified by full- or partial-thickness excision., Intervention: Closure of the rectal wall defect was performed at the surgeon's discretion., Main Outcome Measures: The primary outcome measured was the incidence of 30-day complications., Results: A total of 991 patients were eligible (593 full-thickness excision with 114 open and 479 closed, and 398 partial-thickness excision with 263 open and 135 closed). After matching, balanced cohorts consisting of 220 patients with full-thickness excision and 210 patients with partial-thickness excision were created. Operative time was similar for open and closed defects for both full-and partial-thickness excision. The incidence of 30-day complications was similar for open and closed defects after full- (15% vs. 12%, p = 0.432) and partial-thickness excision (7% vs 5%, p = 0.552). The total number of complications was also similar after full- or partial-thickness excision. Patients undergoing full-thickness excision with open defects had a higher incidence of clinically significant bleeding complications (9% vs 3%, p = 0.045)., Limitations: Data were obtained from 3 institutions with different equipment and perioperative management over a long time period., Conclusions: There was no difference in overall complications between open and closed defects for patients undergoing local excision of rectal neoplasms, but there may be more bleeding complications in open defects after full-thickness excision. A selective approach to defect closure may be appropriate. See Video Abstract at http://links.lww.com/DCR/A470.
- Published
- 2018
- Full Text
- View/download PDF
4. Quality of Local Excision for Rectal Neoplasms Using Transanal Endoscopic Microsurgery Versus Transanal Minimally Invasive Surgery: A Multi-institutional Matched Analysis.
- Author
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Lee L, Edwards K, Hunter IA, Hartley JE, Atallah SB, Albert MR, Hill J, and Monson JR
- Subjects
- Aged, Anal Canal pathology, Cohort Studies, Disease-Free Survival, Female, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Minimally Invasive Surgical Procedures standards, Neoplasm Staging, Operative Time, Outcome and Process Assessment, Health Care, Quality Assurance, Health Care, United Kingdom epidemiology, Anal Canal surgery, Margins of Excision, Neoplasm, Residual etiology, Neoplasm, Residual prevention & control, Rectal Neoplasms epidemiology, Rectal Neoplasms pathology, Rectal Neoplasms surgery, Transanal Endoscopic Microsurgery adverse effects, Transanal Endoscopic Microsurgery methods, Transanal Endoscopic Microsurgery standards
- Abstract
Background: There are no data comparing the quality of local excision of rectal neoplasms using transanal endoscopic microsurgery and transanal minimally invasive surgery., Objective: The purpose of this study was to compare the incidence of tumor fragmentation and positive margins for patients undergoing local excision of benign and malignant rectal neoplasms using transanal endoscopic microsurgery versus transanal minimally invasive surgery., Design: This was a multi-institutional cohort study using coarsened exact matching., Settings: The study was conducted at high-volume tertiary institutions with specialist colorectal surgeons., Patients: Patients undergoing full-thickness local excision for benign and malignant rectal neoplasms were included., Interventions: Transanal endoscopic microsurgery and transanal minimally invasive surgery were the included interventions., Main Outcome Measures: The incidence of poor quality excision (composite measure including tumor fragmentation and/or positive resection margin) was measured., Results: The matched cohort consisted of 428 patients (247 with transanal endoscopic microsurgery and 181 with transanal minimally invasive surgery). Transanal minimally invasive surgery was associated with shorter operative time and length of stay. Poor quality excision was similar (8% vs 11%; p = 0.233). There were also no differences in peritoneal violation (3% vs 3%; p = 0.965) and postoperative complications (11% vs 9%; p = 0.477). Cumulative 5-year disease-free survival for patients undergoing transanal endoscopic microsurgery was 80% compared with 78% for patients undergoing transanal minimally invasive surgery (log rank p = 0.824). The incidence of local recurrence for patients with malignancy who did not undergo immediate salvage surgery was 7% (8/117) for transanal endoscopic microsurgery and 7% (7/94) for transanal minimally invasive surgery (p = 0.864)., Limitations: All of the procedures were also performed at high-volume referral centers by specialist colorectal surgeons with slightly differing perioperative practices and different time periods., Conclusions: High-quality local excision for benign and rectal neoplasms can be equally achieved using transanal endoscopic microsurgery or transanal minimally invasive surgery. The choice of operating platform for local excisions of rectal neoplasms should be based on surgeon preference, availability, and cost. See Video Abstract at http://links.lww.com/DCR/A382.
- Published
- 2017
- Full Text
- View/download PDF
5. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience.
- Author
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O'Neill CH, Platz J, Moore JS, Callas PW, and Cataldo PA
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Chemoradiotherapy, Adjuvant, Female, Humans, Length of Stay, Male, Margins of Excision, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Postoperative Complications epidemiology, Postoperative Hemorrhage epidemiology, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Retrospective Studies, Survival Rate, Treatment Outcome, Urinary Retention epidemiology, Adenocarcinoma surgery, Neoplasm Recurrence, Local epidemiology, Rectal Neoplasms surgery, Rectum surgery, Transanal Endoscopic Microsurgery methods
- Abstract
Background: There is debate regarding the appropriate use of transanal endoscopic microsurgery for rectal cancer., Objective: This study analyzed our single-center experience with transanal endoscopic microsurgery for early rectal cancer., Design: Medical charts of patients who underwent transanal endoscopic microsurgery were reviewed to determine lesion characteristics, as well as operative and treatment characteristics. Complications and recurrences were recorded., Settings: The study was conducted at a single academic medical center., Patients: Patients with early stage cancer (T1 or T2, N0, and M0) of the rectum were included., Main Outcome Measures: Local and overall recurrence and disease-specific survival were measured., Results: A total of 92 patients were analyzed. Median follow-up was 4.6 years. Negative margins were obtained in 98.9%. Length of stay was 1 day for 95.4% of patients. The complication rate was 10.9% (n = 10), including urinary retention at 4.3% (n = 4) and postoperative bleeding at 4.3% (n = 4). Preoperative staging included 54 at T1 (58.7%) and 38 at T2 (41.3%). Adjuvant therapy was recommended for all of the T2 and select T1 lesions with adverse features on histology. The final pathologic stages of tumors were ypT0 at 8.7% (n = 8), pT1 at 58.7% (n = 54), pT2 at 23.9% (n = 22), and ypT2 at 8.7% (n = 8). The 3-year local recurrence risk was 2.4% (SE = 1.7), and overall recurrence was 6.7% (SE = 2.9). There were no recurrences among patients with complete pathologic response to neoadjuvant therapy. Mean time to recurrence was 2.5 years (SD = 1.43). A total of 89.2% of patients with very low tumors underwent curative resection without a permanent stoma (33/37). The 3-year disease-specific survival rate was 98.6% (95% CI, 90.4%-99.8%), and overall survival rate was 89.4% (95% CI, 79.9%-94.6%)., Limitations: The study was limited by its single-center retrospective experience., Conclusions: Transanal endoscopic microsurgery provides comparable oncologic outcomes to radical resection in properly selected patients with early rectal cancer. Sphincter preservation rates approach 90% even in patients with very distal rectal cancer.
- Published
- 2017
- Full Text
- View/download PDF
6. Transanal Total Mesorectal Excision for Rectal Cancer: A Video Demonstration of Rectal Dissection.
- Author
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Hasegawa S, Hida K, Kawada K, and Sakai Y
- Subjects
- Dissection methods, Humans, Rectal Neoplasms surgery, Rectum surgery, Transanal Endoscopic Microsurgery methods
- Published
- 2016
- Full Text
- View/download PDF
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