Fwd: What's new for ' Actualización TEM' in PubMed

2 views

Skip to first unread message

riki BELDA

unread,

Jan 1, 2015, 7:43:43 AM1/1/15

to actualiz...@googlegroups.com

Ricardo Belda Lozano

MD,PhD, MS.

Master en Cirugía Laparoscópica

Master en Coloproctología

http://coloprocto.wordpress.com/

Inicio del mensaje reenviado:

De: My NCBI <efb...@mail.nih.gov>
Fecha: 1 de enero de 2015 12:40:08 GMT+1
Para: <riki...@hotmail.com>
Asunto: What's new for ' Actualizaci??n TEM' in PubMed
Responder a: <riki...@hotmail.com>

This message contains My NCBI what's new results from the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).
Do not reply directly to this message.
Sender's message: Nueva Bibliografía del TEM
Sent on Thursday, 2015 January 01
Search: "Rectum"[Mesh] OR "Rectal Neoplasms"[Mesh] AND "Microsurgery"[Mesh]

View complete results in PubMed (results may change over time).

Edit saved search settings, or unsubscribe from these e-mail updates.

PubMed Results
Items 1 - 6 of 6

1. Dis Colon Rectum. 2014 Nov;57(11):1253-9. doi: 10.1097/DCR.0000000000000215.
Transanal local excision for distal rectal cancer and incomplete response to neoadjuvant chemoradiation - does baseline staging matter?
Perez RO¹, Habr-Gama A, São Julião GP, Proscurshim I, Coelho AQ, Figueiredo MN, Fernandez LM, Gama-Rodrigues J.
Abstract
BACKGROUND:
Local excision may offer the possibility of organ preservation for the management of select patients after neoadjuvant chemoradiation. The oncological outcomes of this strategy have been largely associated with the risk of nodal metastases. Therefore, in addition to final ypT status, baseline staging has been suggested to potentially influence the outcomes of this treatment modality.
OBJECTIVE:
The aim of this study is to compare the pathological and oncological outcomes of patients following neoadjuvant chemoradiation and incomplete clinical response managed by transanal endoscopic microsurgery according to baseline staging.
DESIGN:
This study is a retrospective review of prospectively collected data.
SETTINGS:
The study was conducted at a single center.
PATIENTS:
Forty-six patients with distal rectal cancer cT2-4N0-2M0 underwent 5-fluorouracil-based neoadjuvant chemoradiation. Assessment of response was performed at least 8 weeks from radiotherapy completion. Patients with a complete clinical response were not operated on immediately. Patients with an incomplete clinical response were managed by surgery. Those with small (≤3 cm) residual cancers (ycT1-2N0M0) were managed by transanal endoscopic microsurgery.
MAIN OUTCOME MEASURES:
Patients undergoing local excision following chemoradiation were compared according to baseline staging.
RESULTS:
Fifteen patients (32%) were cT2N0 at baseline. Final ypT status was ypT0 in 3 (20%) patients, ypT1 in 2 (13%) patients, ypT2 in 9 (60%) patients, and ypT3 in 1 (7%) patient. There were no differences in final ypT status in comparison with patients with baseline cT3-4 or cN+ undergoing chemoradiation followed by transanal endoscopic microsurgery (p = 0.38). Local recurrence was observed in 1 patient with baseline cT2N0 (7%) and in 7 patients (23%) with stage II and III (p = 0.18).
LIMITATIONS:
This study was limited by the short follow-up, its limited sample size, and its retrospective and nonrandomized nature.
CONCLUSIONS:
Patients with baseline cT2N0 that do not develop complete response to chemoradiation (ycT0-2N0; ≤3 cm) frequently present unfavorable pathological features for transanal local excision (ypT2 or 3 in >66%). In the presence of incomplete clinical response following chemoradiation, patients with baseline cT2N0 have pathological and oncological outcomes similar to patients with baseline stage II or III and are probably not ideal candidates for local excision (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A159).
PMID: 25285691 [PubMed - indexed for MEDLINE]
Related citations

2. Dis Colon Rectum. 2014 Nov;57(11):1245-52. doi: 10.1097/DCR.0000000000000221.
Long-term outcome of local excision after preoperative chemoradiation for ypT0 rectal cancer.
Stipa F¹, Picchio M, Burza A, Soricelli E, Vitelli CE.
Abstract
BACKGROUND:
Local excision, as an alternative to radical resection for patients with pathological complete response (ypT0) after preoperative chemoradiation, is under investigation.
OBJECTIVE:
The aim of the present study was to evaluate the long-term clinical outcome of a selected group of patients with ypT0 rectal cancer who underwent local excision with transanal endoscopic microsurgery as a definitive treatment.
PATIENTS:
Between 1993 and 2013, 43 patients with rectal adenocarcinoma underwent complete full-thickness local excision with a transanal endoscopic microsurgery procedure after a regimen of chemoradiation. In all patients, rectal wall penetration was preoperatively assessed by endorectal ultrasound and/or magnetic resonance. Chemoradiation and transanal endoscopic microsurgery were indicated in patients refusing radical procedures or patients unfit for major abdominal procedures.
MAIN OUTCOME MEASURES:
Patient characteristics, operative record, pathology report, and tumor recurrence were analyzed at a median follow-up of 81 months. The potential prognostic factors for recurrence, screened in univariate analysis, were analyzed by multivariate analysis by using the Cox regression model.
RESULTS:
Thirteen patients (30.2%), without residual tumor in the surgical specimen (ypT0), were treated with transanal endoscopic microsurgery only. In this ypT0 group, 2 patients (15.4%) had postoperative complications: 1 bleeding and 1 suture dehiscence. Postoperative mortality was nil. No local and distal recurrences were observed, and no tumor-related mortality occurred. In 30 patients (69.8%), partial tumor chemoradiation response or the absence of tumor chemoradiation response was observed. In this group, recurrence occurred in 17 patients (56.7%).
LIMITATIONS:
The study was limited by its retrospective nature, different protocols of chemoradiation and preoperative staging over time, and the small sample size.
CONCLUSIONS:
Local excision with transanal endoscopic microsurgery can be considered a definitive therapeutic option in patients with rectal cancer treated with preoperative chemoradiation, when no residual tumor is found in the specimen. In this selected group, local excision offers excellent results in terms of survival and recurrence rates. In the presence of residual tumor, transanal endoscopic microsurgery should be considered as a large excisional biopsy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A157).
PMID: 25285690 [PubMed - indexed for MEDLINE]
Related citations

3. Int J Colorectal Dis. 2014 May;29(5):605-10. doi: 10.1007/s00384-014-1849-3. Epub 2014 Mar 28.
Transanal endoscopic microsurgery with 3-D (TEM) or high-definition 2-D transanal endoscopic operation (TEO) for rectal tumors. A prospective, randomized clinical trial.
Serra-Aracil X¹, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Navarro-Soto S.
Abstract
PURPOSE:
Transanal endoscopic microsurgery (TEM) is a three-dimensional viewing endoscopic system procedure which provides access to rectal tumors through a rectoscope. Two-dimensional transanal endoscopic operation (TEO), with the introduction of high-definition vision, achieves results that are comparable to those of the classical TEM. The main aim of the study was to compare the effectiveness of TEO and TEM systems in a prospective, randomized clinical trial.
METHOD:

STUDY POPULATION:
patients meeting inclusion criteria for diagnosis of rectal tumors with curative intent. Sample size, 36 patients. Patients were randomized to receive one of the two procedures. Study variables recorded were the following: preoperative data (time taken to assemble equipment, surgical time, quality of pneumorectum), postoperative morbidity and mortality, pathology study of the tumors, and economic analysis.
RESULTS:
Thirty-six patients were analyzed according to intention to treat. Two patients were excluded. The final per-protocol analysis was 34 patients. There were no significant differences in the preoperative or operative variables, quality of pneumorectum, postoperative variables, or pathology results. A trend toward benefit was observed in favor of TEO in time required for assembly, surgical suture time, and total surgical time though the differences were not statistically significant. Statistically significant differences were found in terms of the total cost of the procedure, with mean costs of 2,031 <euro> ± 440 for TEO and 2,603 <euro> ± 507 for TEM (95% CI 218.15-926.486 <euro>, p = 0.003).
CONCLUSION:
No technical or clinical differences were observed between the results obtained with the two systems except lower cost with TEO.
PMID: 24676506 [PubMed - indexed for MEDLINE]
Related citations

4. Minim Invasive Ther Allied Technol. 2014 Mar;23(2):63-9. doi: 10.3109/13645706.2014.893891.
Pitfalls of transanal endoscopic microsurgery for rectal cancer following neoadjuvant chemoradiation therapy.
Habr-Gama A¹, São Julião GP, Perez RO.
Abstract
Transanal endoscopic microsurgery has become a very useful surgical tool for the management of selected cases of rectal cancer. However, the considerably high local recurrence rates led to the introduction of neoadjuvant therapies including radiation with or without chemotherapy. This treatment strategy may result in significant rates of tumor regression allowing the procedure to be offered to a significant proportion of cases. On the other hand, neoadjuvant chemoradiation (CRT) may also determine wound-healing difficulties with significant postoperative pain. In addition, salvage total mesorectal excision in the case of local recurrence may also be a challenging task. Finally, accurate selection criteria for this minimally invasive approach are still lacking and may be influenced by baseline staging, post-treatment staging and final pathology information. Ultimately, selection of patients for this treatment modality remains a significant challenge for the colorectal surgeon who should be aware of the pitfalls of this procedure in the setting of neoadjuvant CRT.
PMID: 24635719 [PubMed - indexed for MEDLINE]
Related citations

5. Minim Invasive Ther Allied Technol. 2014 Mar;23(2):70-3. doi: 10.3109/13645706.2014.887022. Epub 2014 Feb 3.
Synchronous laparoscopic low anterior and transanal endoscopic microsurgery total mesorectal resection.
Meng W¹, Lau K.
Abstract
BACKGROUND:
Laparoscopic low anterior resection (Lap LAR) and total mesorectal excision (TME) is the standard minimally invasive surgery (MIS) for mid and low rectal tumours. However, the pelvic resection in particular for bulky tumour in the narrow male pelvis has always been a challenge for surgeons. Transanal endoscopic microsurgery (TEM) is a well-established technique and synchronous abdomino-perineal excision of rectum (APER) is also a standard procedure. Hence, we applied the same concept to Synchronous Lap LAR and Transanal-TME.
MATERIAL AND METHODS:
Transanal TME was carried out with TEM instruments and rectoscope. Synchronous Lap LAR was performed and dissection joined to the pelvic part. The specimen was then retrieved via extension of the left lower quadrant port. An anvil was inserted into the proximal colon and intracorporeal transrectal anastomosis was performed to reconstitute the continuity of the bowel.
RESULTS:
We reported the feasibility of transanal total mesorectal excision (TME) by combination of Synchronous Lap LAR and TEM. We operated on three cases, two male patients and one female patient. We performed an intracorporeal transanal stapled coloanal anastomosis in all of them using the KOL perineal set (Touchstone, Suzhou, Jiangsu, China). The trans-abdominal and transanal dissection can be joined together with ease and accuracy.
CONCLUSIONS:
Transanal total mesorectal excision (TME) by synchronous Lap LAR and TEM is feasible. We combine operative techniques which are well established, currently available and cost-effective for bulky tumour in the narrow pelvis.
PMID: 24483132 [PubMed - indexed for MEDLINE]
Related citations

6. Surg Endosc. 2014 Jun;28(6):1874-8. doi: 10.1007/s00464-013-3407-4. Epub 2014 Jan 11.
TEMS: results of a specialist centre.
Flexer SM¹, Durham-Hall AC, Steward MA, Robinson JM.
Abstract
INTRODUCTION:
Transanal endoscopic microsurgery (TEMS) is becoming more widespread due to the increasing body of evidence to support its role. Previous published data has reported recurrence rates in excess of 10% for benign polyps after TEMS.
METHODS:
Bradford Royal Infirmary is a tertiary referral centre for TEMS and early rectal cancer in the UK. Data for all TEMS operations were entered into a prospective database over a 7-year period. Demographic data, complications and recurrence rates were recorded. Both benign adenomas and malignant lesions were included.
RESULTS:
A total of 164 patients (65% male), with a mean age of 68 years were included; 114 (70%) of the lesions resected were benign adenomas, and 50 (30%) were malignant lesions. Median polyp size was 4 (range 0.6-14.5) cm. Mean length of operation was 55 (range 10-120) min. There were no recurrences in any patients with a benign adenoma resected; two patients with malignant lesions developed recurrences. Three intra-operative complications were recorded, two rectal perforations (repaired primarily, one requiring defunctioning stoma), and a further patient suffered a blood loss of >300 ml requiring transfusion. Six patients developed strictures requiring dilation either endoscopically or under anaesthetic in the post-operative period.
CONCLUSIONS:
We have demonstrated that TEMS procedures performed in a specialist centre provide low rates of both recurrence and complication. Within a specialist centre, TEMS surgery should be offered to all patients for rectal lesions, both benign and malignant, that are amenable to TEMS.
PMID: 24414462 [PubMed - indexed for MEDLINE]
Related citations

Reply all

Reply to author

Forward

0 new messages

1.	Dis Colon Rectum. 2014 Nov;57(11):1253-9. doi: 10.1097/DCR.0000000000000215. Transanal local excision for distal rectal cancer and incomplete response to neoadjuvant chemoradiation - does baseline staging matter? Perez RO¹, Habr-Gama A, São Julião GP, Proscurshim I, Coelho AQ, Figueiredo MN, Fernandez LM, Gama-Rodrigues J. Abstract BACKGROUND: Local excision may offer the possibility of organ preservation for the management of select patients after neoadjuvant chemoradiation. The oncological outcomes of this strategy have been largely associated with the risk of nodal metastases. Therefore, in addition to final ypT status, baseline staging has been suggested to potentially influence the outcomes of this treatment modality. OBJECTIVE: The aim of this study is to compare the pathological and oncological outcomes of patients following neoadjuvant chemoradiation and incomplete clinical response managed by transanal endoscopic microsurgery according to baseline staging. DESIGN: This study is a retrospective review of prospectively collected data. SETTINGS: The study was conducted at a single center. PATIENTS: Forty-six patients with distal rectal cancer cT2-4N0-2M0 underwent 5-fluorouracil-based neoadjuvant chemoradiation. Assessment of response was performed at least 8 weeks from radiotherapy completion. Patients with a complete clinical response were not operated on immediately. Patients with an incomplete clinical response were managed by surgery. Those with small (≤3 cm) residual cancers (ycT1-2N0M0) were managed by transanal endoscopic microsurgery. MAIN OUTCOME MEASURES: Patients undergoing local excision following chemoradiation were compared according to baseline staging. RESULTS: Fifteen patients (32%) were cT2N0 at baseline. Final ypT status was ypT0 in 3 (20%) patients, ypT1 in 2 (13%) patients, ypT2 in 9 (60%) patients, and ypT3 in 1 (7%) patient. There were no differences in final ypT status in comparison with patients with baseline cT3-4 or cN+ undergoing chemoradiation followed by transanal endoscopic microsurgery (p = 0.38). Local recurrence was observed in 1 patient with baseline cT2N0 (7%) and in 7 patients (23%) with stage II and III (p = 0.18). LIMITATIONS: This study was limited by the short follow-up, its limited sample size, and its retrospective and nonrandomized nature. CONCLUSIONS: Patients with baseline cT2N0 that do not develop complete response to chemoradiation (ycT0-2N0; ≤3 cm) frequently present unfavorable pathological features for transanal local excision (ypT2 or 3 in >66%). In the presence of incomplete clinical response following chemoradiation, patients with baseline cT2N0 have pathological and oncological outcomes similar to patients with baseline stage II or III and are probably not ideal candidates for local excision (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A159).
	PMID: 25285691 [PubMed - indexed for MEDLINE]
	Related citations

2.	Dis Colon Rectum. 2014 Nov;57(11):1245-52. doi: 10.1097/DCR.0000000000000221. Long-term outcome of local excision after preoperative chemoradiation for ypT0 rectal cancer. Stipa F¹, Picchio M, Burza A, Soricelli E, Vitelli CE. Abstract BACKGROUND: Local excision, as an alternative to radical resection for patients with pathological complete response (ypT0) after preoperative chemoradiation, is under investigation. OBJECTIVE: The aim of the present study was to evaluate the long-term clinical outcome of a selected group of patients with ypT0 rectal cancer who underwent local excision with transanal endoscopic microsurgery as a definitive treatment. PATIENTS: Between 1993 and 2013, 43 patients with rectal adenocarcinoma underwent complete full-thickness local excision with a transanal endoscopic microsurgery procedure after a regimen of chemoradiation. In all patients, rectal wall penetration was preoperatively assessed by endorectal ultrasound and/or magnetic resonance. Chemoradiation and transanal endoscopic microsurgery were indicated in patients refusing radical procedures or patients unfit for major abdominal procedures. MAIN OUTCOME MEASURES: Patient characteristics, operative record, pathology report, and tumor recurrence were analyzed at a median follow-up of 81 months. The potential prognostic factors for recurrence, screened in univariate analysis, were analyzed by multivariate analysis by using the Cox regression model. RESULTS: Thirteen patients (30.2%), without residual tumor in the surgical specimen (ypT0), were treated with transanal endoscopic microsurgery only. In this ypT0 group, 2 patients (15.4%) had postoperative complications: 1 bleeding and 1 suture dehiscence. Postoperative mortality was nil. No local and distal recurrences were observed, and no tumor-related mortality occurred. In 30 patients (69.8%), partial tumor chemoradiation response or the absence of tumor chemoradiation response was observed. In this group, recurrence occurred in 17 patients (56.7%). LIMITATIONS: The study was limited by its retrospective nature, different protocols of chemoradiation and preoperative staging over time, and the small sample size. CONCLUSIONS: Local excision with transanal endoscopic microsurgery can be considered a definitive therapeutic option in patients with rectal cancer treated with preoperative chemoradiation, when no residual tumor is found in the specimen. In this selected group, local excision offers excellent results in terms of survival and recurrence rates. In the presence of residual tumor, transanal endoscopic microsurgery should be considered as a large excisional biopsy (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A157).
	PMID: 25285690 [PubMed - indexed for MEDLINE]
	Related citations

3.	Int J Colorectal Dis. 2014 May;29(5):605-10. doi: 10.1007/s00384-014-1849-3. Epub 2014 Mar 28. Transanal endoscopic microsurgery with 3-D (TEM) or high-definition 2-D transanal endoscopic operation (TEO) for rectal tumors. A prospective, randomized clinical trial. Serra-Aracil X¹, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Navarro-Soto S. Abstract PURPOSE: Transanal endoscopic microsurgery (TEM) is a three-dimensional viewing endoscopic system procedure which provides access to rectal tumors through a rectoscope. Two-dimensional transanal endoscopic operation (TEO), with the introduction of high-definition vision, achieves results that are comparable to those of the classical TEM. The main aim of the study was to compare the effectiveness of TEO and TEM systems in a prospective, randomized clinical trial. METHOD: STUDY POPULATION: patients meeting inclusion criteria for diagnosis of rectal tumors with curative intent. Sample size, 36 patients. Patients were randomized to receive one of the two procedures. Study variables recorded were the following: preoperative data (time taken to assemble equipment, surgical time, quality of pneumorectum), postoperative morbidity and mortality, pathology study of the tumors, and economic analysis. RESULTS: Thirty-six patients were analyzed according to intention to treat. Two patients were excluded. The final per-protocol analysis was 34 patients. There were no significant differences in the preoperative or operative variables, quality of pneumorectum, postoperative variables, or pathology results. A trend toward benefit was observed in favor of TEO in time required for assembly, surgical suture time, and total surgical time though the differences were not statistically significant. Statistically significant differences were found in terms of the total cost of the procedure, with mean costs of 2,031 <euro> ± 440 for TEO and 2,603 <euro> ± 507 for TEM (95% CI 218.15-926.486 <euro>, p = 0.003). CONCLUSION: No technical or clinical differences were observed between the results obtained with the two systems except lower cost with TEO.
	PMID: 24676506 [PubMed - indexed for MEDLINE]
	Related citations

4.	Minim Invasive Ther Allied Technol. 2014 Mar;23(2):63-9. doi: 10.3109/13645706.2014.893891. Pitfalls of transanal endoscopic microsurgery for rectal cancer following neoadjuvant chemoradiation therapy. Habr-Gama A¹, São Julião GP, Perez RO. Abstract Transanal endoscopic microsurgery has become a very useful surgical tool for the management of selected cases of rectal cancer. However, the considerably high local recurrence rates led to the introduction of neoadjuvant therapies including radiation with or without chemotherapy. This treatment strategy may result in significant rates of tumor regression allowing the procedure to be offered to a significant proportion of cases. On the other hand, neoadjuvant chemoradiation (CRT) may also determine wound-healing difficulties with significant postoperative pain. In addition, salvage total mesorectal excision in the case of local recurrence may also be a challenging task. Finally, accurate selection criteria for this minimally invasive approach are still lacking and may be influenced by baseline staging, post-treatment staging and final pathology information. Ultimately, selection of patients for this treatment modality remains a significant challenge for the colorectal surgeon who should be aware of the pitfalls of this procedure in the setting of neoadjuvant CRT.
	PMID: 24635719 [PubMed - indexed for MEDLINE]
	Related citations

5.	Minim Invasive Ther Allied Technol. 2014 Mar;23(2):70-3. doi: 10.3109/13645706.2014.887022. Epub 2014 Feb 3. Synchronous laparoscopic low anterior and transanal endoscopic microsurgery total mesorectal resection. Meng W¹, Lau K. Abstract BACKGROUND: Laparoscopic low anterior resection (Lap LAR) and total mesorectal excision (TME) is the standard minimally invasive surgery (MIS) for mid and low rectal tumours. However, the pelvic resection in particular for bulky tumour in the narrow male pelvis has always been a challenge for surgeons. Transanal endoscopic microsurgery (TEM) is a well-established technique and synchronous abdomino-perineal excision of rectum (APER) is also a standard procedure. Hence, we applied the same concept to Synchronous Lap LAR and Transanal-TME. MATERIAL AND METHODS: Transanal TME was carried out with TEM instruments and rectoscope. Synchronous Lap LAR was performed and dissection joined to the pelvic part. The specimen was then retrieved via extension of the left lower quadrant port. An anvil was inserted into the proximal colon and intracorporeal transrectal anastomosis was performed to reconstitute the continuity of the bowel. RESULTS: We reported the feasibility of transanal total mesorectal excision (TME) by combination of Synchronous Lap LAR and TEM. We operated on three cases, two male patients and one female patient. We performed an intracorporeal transanal stapled coloanal anastomosis in all of them using the KOL perineal set (Touchstone, Suzhou, Jiangsu, China). The trans-abdominal and transanal dissection can be joined together with ease and accuracy. CONCLUSIONS: Transanal total mesorectal excision (TME) by synchronous Lap LAR and TEM is feasible. We combine operative techniques which are well established, currently available and cost-effective for bulky tumour in the narrow pelvis.
	PMID: 24483132 [PubMed - indexed for MEDLINE]
	Related citations

6.	Surg Endosc. 2014 Jun;28(6):1874-8. doi: 10.1007/s00464-013-3407-4. Epub 2014 Jan 11. TEMS: results of a specialist centre. Flexer SM¹, Durham-Hall AC, Steward MA, Robinson JM. Abstract INTRODUCTION: Transanal endoscopic microsurgery (TEMS) is becoming more widespread due to the increasing body of evidence to support its role. Previous published data has reported recurrence rates in excess of 10% for benign polyps after TEMS. METHODS: Bradford Royal Infirmary is a tertiary referral centre for TEMS and early rectal cancer in the UK. Data for all TEMS operations were entered into a prospective database over a 7-year period. Demographic data, complications and recurrence rates were recorded. Both benign adenomas and malignant lesions were included. RESULTS: A total of 164 patients (65% male), with a mean age of 68 years were included; 114 (70%) of the lesions resected were benign adenomas, and 50 (30%) were malignant lesions. Median polyp size was 4 (range 0.6-14.5) cm. Mean length of operation was 55 (range 10-120) min. There were no recurrences in any patients with a benign adenoma resected; two patients with malignant lesions developed recurrences. Three intra-operative complications were recorded, two rectal perforations (repaired primarily, one requiring defunctioning stoma), and a further patient suffered a blood loss of >300 ml requiring transfusion. Six patients developed strictures requiring dilation either endoscopically or under anaesthetic in the post-operative period. CONCLUSIONS: We have demonstrated that TEMS procedures performed in a specialist centre provide low rates of both recurrence and complication. Within a specialist centre, TEMS surgery should be offered to all patients for rectal lesions, both benign and malignant, that are amenable to TEMS.
	PMID: 24414462 [PubMed - indexed for MEDLINE]
	Related citations