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Ricardo Belda Lozano

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Master en Cirugía Laparoscópica

Master en Coloproctología

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PubMed Results
Items 1 - 9 of 9

1. APMIS. 2014 Aug;122(8):715-22. doi: 10.1111/apm.12292.
Local resection of early rectal cancer.
Baatrup G¹, Qvist N.
Author information:
¹Institute of Regional Health, Medical Faculty, University of Southern Denmark, Svendborg, Denmark; Department of Surgery A, Odense University Hospital, Svendborg, Denmark.
Abstract
The introduction of the National Danish screening programme for colorectal cancer will result in the detection of more early rectal cancers (ERC), which may be considered for local excision. For the low risk≤T1 cancer, the oncological outcome at local excision in smaller patient series has shown similar results to conventional surgery, but with a significantly lower rate of serious complications, morbidity and mortality. The challenge is correct preoperative staging, and a meticulous systematic histopathological staging of the excised specimen to distinguish the low risk from high-risk cases, where rescue surgery may be considered. The establishment of a regional or national clinical database is necessary to improve the local treatment of ERC.
© 2014 APMIS. Published by John Wiley & Sons Ltd.
PMID: 25046201 [PubMed - indexed for MEDLINE]
Related citations

2. BMJ Case Rep. 2014 Mar 12;2014. pii: bcr2013202864. doi: 10.1136/bcr-2013-202864.
Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS).
Chandra A¹, Clarke R, Shawkat H.
Author information:
¹Department of Colorectal Surgery, Shrewsbury and Telford NHS Trust, Shrewsbury, Shropshire, UK.
Abstract
We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).
PMID: 24623543 [PubMed - indexed for MEDLINE]
Related citations

3. Surg Endosc. 2014 Jul;28(7):2066-71. doi: 10.1007/s00464-014-3428-7. Epub 2014 Feb 12.
Transanal endoscopic microsurgery for upper rectal tumors.
Khoury W¹, Igov I, Issa N, Gimelfarb Y, Duek SD.
Author information:
¹Department of General Surgery, Rambam Health Care Campus, 8th Ha'alia St, Haifa, Israel, wekh...@gmail.com.
Abstract
BACKGROUND:
Compared with traditional rectal resection, transanal endoscopic microsurgery (TEM) is faster and safer. This retrospective study sought to assess the efficacy of TEM for lesions located in the upper rectum, ≥10 cm from the anal verge.
METHODS:
Data from all patients who underwent TEM for rectal lesions ≥10 cm from the anal verge between 2001 and 2010 at two medical centers in Israel were retrospectively analyzed. The study group comprised 96 patients (57 men, 39 women) who underwent 99 TEM procedures. Collected data included patient demographics, tumor characteristics, indications for surgery, operative findings and details, postoperative outcomes, and histopathologic findings. Long-term outcomes including local recurrence (LR) for benign lesions and LR and overall survival (OS) for malignant lesions were calculated. Categorical variables were calculated by frequency tables, and linear variables were represented by averages and standard deviation or median with the spread of variables. Survival and LR analysis was performed by Kaplan-Meier and Cox regression methods.
RESULTS:
The mean tumor distance from the anal verge was 11.3 ± 2 cm and the median tumor size was 2 cm. Early postoperative outcomes were favorable, and no early postoperative mortality was reported. The postoperative morbidity rate was 10%. For long-term outcomes, in the subgroup with benign lesions, after a median follow-up of 8.7 years, the LR rate was 5.1%. In the group with malignant lesions, LR and OS rates were 6.9 and 87%, respectively.
CONCLUSIONS:
TEM for upper rectal lesions is feasible and may be safe in selected cases. Low morbidity rate, shorter operative time and length of stay, no mortality events, and favorable long-term outcomes support the use of TEM for the treatment of lesions in the upper rectum.
PMID: 24519026 [PubMed - indexed for MEDLINE]
Related citations

4. Surg Endosc. 2014 Apr;28(4):1173-9.
Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer.
Shiguehissa Kawaguti FS, Rizkallah Nahas CS, Sparapan Marques CF, da Costa Martins B, Alves Retes F, Medeiros RS, Hayashi T, Wada Y, de Lima MS, Sato Uemura R, Carlos Nahas SC, Kudo SE, Maluf-Filho F.
Abstract
BACKGROUND:
Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that can be used to treat early rectal cancer.
OBJECTIVE:
The aim of this study was to compare clinical efficacy between ESD and TEM for the treatment of early rectal cancer.
METHODS:
Between July 2008 and August 2011, 24 patients with early rectal cancers were treated by ESD (11) or TEM (13) at the Cancer Institute of São Paulo University Medical School (São Paulo, Brazil). Data were analyzed retrospectively according to database and pathological reports, with respect to en bloc resection rate, local recurrence, complications, histological diagnosis, procedure time and length of hospital stay.
RESULTS:
En bloc resection rates with free margins were achieved in 81.8 % of patients in the ESD group and 84.6 % of patients in the TEM group (p = 0.40). Mean tumor size was 64.6 ± 57.9 mm in the ESD group and 43.9 ± 30.7 mm in the TEM group (p = 0.13). Two patients in the TEM group and one patient in the ESD group had a local recurrence. The mean procedure time was 133 ± 94.8 min in the ESD group and 150 ± 66.3 min in the TEM group (p = 0.69). Mean hospital stay was 3.8 ± 3.3 days in the ESD group and 4.08 ± 1.7 days in the TEM group (p = 0.81).
LIMITATIONS:
This was a non-randomized clinical trial with a small sample size and selection bias in treatment options.
CONCLUSION:
ESD and TEM are both safe and effective for the treatment of early rectal cancer.
PMID: 24232053 [PubMed - indexed for MEDLINE]
Related citations

5. Surg Endosc. 2014 Apr;28(4):1136-40. doi: 10.1007/s00464-013-3290-z. Epub 2013 Oct 30.
Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment.
Arolfo S¹, Allaix ME, Migliore M, Cravero F, Arezzo A, Morino M.
Author information:
¹Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy, simone...@tiscali.it.
Abstract
BACKGROUND:
Management of malignant rectal polyps (MRPs) after endoscopic polypectomy (EP) is still debated. It is sometimes difficult to decide whether to simply follow-up (FU) or to treat such a removed lesion. Transanal endoscopic microsurgery (TEM) could have a role both in T staging and in treating MRPs after EP.
METHODS:
Patients who underwent a full-thickness TEM within 3 months after an EP between January 2008 and October 2012 were retrospectively analyzed. If post-TEM histology showed locally advanced rectal cancer, patients underwent a total mesorectal excision (TME) within 4-6 weeks. Patients without malignant disease or pT1sm1 cancers at post-TEM histology were followed up every 3 months for 2 years with clinical examination, flexible rectal endoscopy, and neoplastic markers monitoring.
RESULTS:
A total of 39 patients were included. Post-EP histology was adenocarcinoma in 27/39 cases (69.2 %) and adenoma in 12/39. Mean operative time was 64.2 min; no 30-day mortality occurred; 30-day morbidity was 2.7 % (rectal bleeding in 1/39 cases). Post-TEM histology showed a T2 cancer in 5/39 patients, four with and one without a previous cancer diagnosis, who were further treated by TME (four RARs and one APR) and are disease free with a mean FU of 24.2 months. Post-TEM histology showed adenoma in 10/39 cases and fibrosis in 24/39. These patients are disease free with a mean FU of 13 months.
CONCLUSIONS:
A full-thickness TEM after EP of MRPs can establish the presence of residual malignant disease and its depth of invasion, precisely defining the indication to TME. In event of benign post-EP histology, TEM must be performed in presence of macroscopic residual disease, in order to obtain an RO resection and finally exclude cancer, while, in absence of macroscopic residual disease, only close FU is required.
PMID: 24170069 [PubMed - indexed for MEDLINE]
Related citations

6. Surg Endosc. 2014 Jan;28(1):271-80. doi: 10.1007/s00464-013-3184-0. Epub 2013 Sep 6.
Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia.
Lee TG¹, Lee SJ.
Author information:
¹Department of Surgery, College of Medicine, Chungbuk National University, 52 Naesudong-ro, Heungdeok-gu, Cheongju, 361-763, Chungbuk, South Korea, nine...@hanmail.net.
Abstract
BACKGROUND:
Transanal minimally invasive surgery (TAMIS) for rectal tumors has been introduced as an alternative approach to transanal endoscopic microsurgery (TEM). TEM has some limitations, such as the need for special equipment, expensive cost, and steep learning curve. In this study, we address the technical feasibility of TAMIS under spinal anesthesia and its short-term postoperative outcomes.
METHODS:
From July 2011 to September 2012, 25 consecutive patients with middle or upper third rectal masses underwent TAMIS. Tumors were located 6-17 cm from the anal verge. After spinal anesthesia, a single-incision laparoscopic surgery port was inserted into the anal canal. With this access, conventional laparoscopic instruments, including a grasper and monopolar electrocautery and suction device, were used to perform the transanal excision. A hook-type monopolar electrocautery or harmonic scalpel was used for dissection. The defect of the rectum was closed by interrupted sutures. Data concerning demographics, details of operative procedure, postoperative pain, and pathologic results were collected prospectively. To evaluate anal sphincter injury, an endoanal ultrasonography and fecal incontinence severity index survey were performed at 3-6 months after the operation.
RESULTS:
Of the 25 patients, nine had adenocarcinomas, nine had neuroendocrine tumors, three had tubular adenomas with high-grade dysplasia, three had tubular adenomas, one had a tubulovillous adenoma, and one had a gastrointestinal stromal tumor. The median distance from the tumor mass to the anal verge was 9.0 (range 6-17) cm. The median operative time was 45.0 (range 20-120) min. All patients received TAMIS without conversion to laparoscopic resection. There were no intraoperative complications or postoperative morbidity. The median postoperative hospital stay was 3.0 (range 2-7) days. No sphincter injury was detected by endoanal ultrasonography.
CONCLUSIONS:
TAMIS under spinal anesthesia is a safe and feasible technique for resection of middle and upper rectal masses. Spinal anesthesia is adequate for this procedure.
PMID: 24061623 [PubMed - indexed for MEDLINE]
Related citations

7. Surg Endosc. 2014 Jan;28(1):193-202. doi: 10.1007/s00464-013-3155-5. Epub 2013 Sep 12.
Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions.
Valsdottir EB¹, Yarandi SS, Marks JH, Marks GJ.
Author information:
¹Department of Colorectal Surgery, Lankenau Hospital and Institute of Medical Research, 100 Lancaster Avenue, Medical Office Building West, Suite 330, Wynnewood, PA, 19096, USA.
Abstract
BACKGROUND:
Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter's musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years.
METHODS:
A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment.
RESULTS:
Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence.
CONCLUSION:
Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.
PMID: 24026565 [PubMed - indexed for MEDLINE]
Related citations

8. Surg Endosc. 2014 Jan;28(1):227-34. doi: 10.1007/s00464-013-3166-2. Epub 2013 Sep 4.
Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision.
Lezoche E¹, Paganini AM, Fabiani B, Balla A, Vestri A, Pescatori L, Scoglio D, D'Ambrosio G, Lezoche G.
Author information:
¹Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Abstract
BACKGROUND:
For selected patients with rectal cancer, endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Few data are available on quality of life (QoL) after LTME and TEM. This study aimed to compare short- and medium-term QoL for T1 rectal cancer patients undergoing LTME or ELRR by TEM.
METHODS:
This study investigated 35 patients with T1N0 rectal cancer who underwent TEM (n = 17) or LTME (n = 18). Quality of life was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C38 questionnaires preoperatively and then 1, 6, and 12 months after surgery.
RESULTS:
Observation 1 month after LTME showed worsening in all items of both questionnaires. After ELRR, the QLQ-CR38 showed worsening of gastrointestinal (p = 0.005) and defecation problems (p = 0.001), and the QLQ-C30 showed worsening of global health status (p = 0.014), physical functioning (p = 0.02) role functioning (p = 0.003), fatigue (p = 0.002), and pain (p = 0.001). The QLQ-CR38 6 months after LTME showed worsening of body image (p = 0.009), micturition (p = 0.035), and gastrointestinal problems (p = 0.011), and the QLQ-C30 showed worsening of physical functioning (p = 0.003), role functioning (p = 0.002), fatigue (p = 0.004), and nausea/vomiting (p = 0.030). After ELRR, neither the QLQ-CR38 nor the QLQ-C30 questionnaire showed any worsening but demonstrated improvement in global health status and physical functioning. The QLQ-CR38 12 months after LTME showed significant improvement in defecation problems (p = 0.004) and weight loss (p = 0.003), and the QLQ-C30 showed significant improvement in global health status (p = 0.001), nausea and vomiting (p = 0.003), and pain (p = 0.005). After ELRR, the QLQ-C30 showed improvement in emotional functioning (p = 0.012), whereas no significant difference was observed by the QLQ-C38.
CONCLUSIONS:
Functional sequelae are present up to 1 month only after ELRR by TEM and up to 6 months after LTME. At 12 months, neither procedure showed a significant difference in QoL compared with preoperative status.
PMID: 24002918 [PubMed - indexed for MEDLINE]
Related citations

9. Tech Coloproctol. 2014 Feb;18(2):157-64. doi: 10.1007/s10151-013-1040-9. Epub 2013 Jun 28.
Atypical indications for transanal endoscopic microsurgery to avoid major surgery.
Serra-Aracil X¹, Mora-Lopez L, Alcantara-Moral M, Corredera-Cantarin C, Gomez-Diaz C, Navarro-Soto S.
Author information:
¹Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Autonomous University of Barcelona, 08208, Sabadell, Barcelona, Spain, jse...@tauli.cat.
Abstract
BACKGROUND:
Transanal endoscopic microsurgery (TEM) was originally designed for the removal of rectal tumors, principally incipient adenomas, and adenocarcinomas up to 20 cm from the anal verge. However, with the evolution of the technique and the increase in surgeons' experience, new indications have emerged and TEM may now be used in place of other surgical procedures which are associated with higher morbidity. The aim of our study was to evaluate our group's use of TEM or transanal endoscopic operations (TEO) for conditions other than rectal tumors.
METHODS:
An observational study of TEM (using Wolf equipment) or TEO (using Storz equipment) for indications other than excision of rectal tumors was conducted from June 2004 to July 2012.
RESULTS:
Four hundred twenty-four procedures were performed using TEM/TEO: removal of adenocarcinomas in 148 (34.9 %) patients, adenomas in 236 (55.7 %), post-polypectomy excision in 12 (2.8 %), removal of neuroendocrine tumors in 8 (1.9 %), and atypical indications in 20 (4.7 %). Atypical indications were pelvic abscess (3), benign rectal stenoses (2), rectourethral fistula after prostatectomy (3), gastrointestinal stromal tumor (3), endorectal condylomata acuminata (1), rectal prolapse (2), extraction of impacted fecaloma in the rectosigmoid junction (1), repair of traumatic and iatrogenic perforation of the rectum (2), and presacral tumor (3).
CONCLUSIONS:
The use of TEM/TEO in atypical indications may benefit patients by avoiding surgical procedures associated with greater morbidity.
PMID: 23813055 [PubMed - indexed for MEDLINE]
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1.	APMIS. 2014 Aug;122(8):715-22. doi: 10.1111/apm.12292. Local resection of early rectal cancer. Baatrup G¹, Qvist N. Author information: ¹Institute of Regional Health, Medical Faculty, University of Southern Denmark, Svendborg, Denmark; Department of Surgery A, Odense University Hospital, Svendborg, Denmark. Abstract The introduction of the National Danish screening programme for colorectal cancer will result in the detection of more early rectal cancers (ERC), which may be considered for local excision. For the low risk≤T1 cancer, the oncological outcome at local excision in smaller patient series has shown similar results to conventional surgery, but with a significantly lower rate of serious complications, morbidity and mortality. The challenge is correct preoperative staging, and a meticulous systematic histopathological staging of the excised specimen to distinguish the low risk from high-risk cases, where rescue surgery may be considered. The establishment of a regional or national clinical database is necessary to improve the local treatment of ERC. © 2014 APMIS. Published by John Wiley & Sons Ltd.
	PMID: 25046201 [PubMed - indexed for MEDLINE]
	Related citations

2.	BMJ Case Rep. 2014 Mar 12;2014. pii: bcr2013202864. doi: 10.1136/bcr-2013-202864. Intraoperative hypercarbia and massive surgical emphysema secondary to transanal endoscopic microsurgery (TEMS). Chandra A¹, Clarke R, Shawkat H. Author information: ¹Department of Colorectal Surgery, Shrewsbury and Telford NHS Trust, Shrewsbury, Shropshire, UK. Abstract We describe a case where full-thickness excision of a rectal lesion caused massive surgical emphysema and subsequent hypercarbia with associated difficulties with ventilation. This unique case highlights the risks of respiratory failure with extraperitoneal insufflation as in this case and as more commonly with intraperitoneal insufflation. Transanal endoscopic microsurgery (TEMS) is a technique that is being increasingly used in the management of large and early malignant rectal polyps. We reviewed the literature in order to understand the case and to highlight factors that should minimise any adverse sequelae. In the presence of ventilatory difficulties secondary to postoperative surgical emphysema, whether via extraperitoneal insufflation as described here or with intraperitoneal insufflation (as in laparoscopy), consider decreasing gas pressures, expediting the procedure, delaying extubation and prolonged close monitoring in recovery with possible admission to a high dependency unit (HDU) or intensive care unit (ICU).
	PMID: 24623543 [PubMed - indexed for MEDLINE]
	Related citations

3.	Surg Endosc. 2014 Jul;28(7):2066-71. doi: 10.1007/s00464-014-3428-7. Epub 2014 Feb 12. Transanal endoscopic microsurgery for upper rectal tumors. Khoury W¹, Igov I, Issa N, Gimelfarb Y, Duek SD. Author information: ¹Department of General Surgery, Rambam Health Care Campus, 8th Ha'alia St, Haifa, Israel, wekh...@gmail.com. Abstract BACKGROUND: Compared with traditional rectal resection, transanal endoscopic microsurgery (TEM) is faster and safer. This retrospective study sought to assess the efficacy of TEM for lesions located in the upper rectum, ≥10 cm from the anal verge. METHODS: Data from all patients who underwent TEM for rectal lesions ≥10 cm from the anal verge between 2001 and 2010 at two medical centers in Israel were retrospectively analyzed. The study group comprised 96 patients (57 men, 39 women) who underwent 99 TEM procedures. Collected data included patient demographics, tumor characteristics, indications for surgery, operative findings and details, postoperative outcomes, and histopathologic findings. Long-term outcomes including local recurrence (LR) for benign lesions and LR and overall survival (OS) for malignant lesions were calculated. Categorical variables were calculated by frequency tables, and linear variables were represented by averages and standard deviation or median with the spread of variables. Survival and LR analysis was performed by Kaplan-Meier and Cox regression methods. RESULTS: The mean tumor distance from the anal verge was 11.3 ± 2 cm and the median tumor size was 2 cm. Early postoperative outcomes were favorable, and no early postoperative mortality was reported. The postoperative morbidity rate was 10%. For long-term outcomes, in the subgroup with benign lesions, after a median follow-up of 8.7 years, the LR rate was 5.1%. In the group with malignant lesions, LR and OS rates were 6.9 and 87%, respectively. CONCLUSIONS: TEM for upper rectal lesions is feasible and may be safe in selected cases. Low morbidity rate, shorter operative time and length of stay, no mortality events, and favorable long-term outcomes support the use of TEM for the treatment of lesions in the upper rectum.
	PMID: 24519026 [PubMed - indexed for MEDLINE]
	Related citations

4.	Surg Endosc. 2014 Apr;28(4):1173-9. Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Shiguehissa Kawaguti FS, Rizkallah Nahas CS, Sparapan Marques CF, da Costa Martins B, Alves Retes F, Medeiros RS, Hayashi T, Wada Y, de Lima MS, Sato Uemura R, Carlos Nahas SC, Kudo SE, Maluf-Filho F. Abstract BACKGROUND: Endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) are minimally invasive procedures that can be used to treat early rectal cancer. OBJECTIVE: The aim of this study was to compare clinical efficacy between ESD and TEM for the treatment of early rectal cancer. METHODS: Between July 2008 and August 2011, 24 patients with early rectal cancers were treated by ESD (11) or TEM (13) at the Cancer Institute of São Paulo University Medical School (São Paulo, Brazil). Data were analyzed retrospectively according to database and pathological reports, with respect to en bloc resection rate, local recurrence, complications, histological diagnosis, procedure time and length of hospital stay. RESULTS: En bloc resection rates with free margins were achieved in 81.8 % of patients in the ESD group and 84.6 % of patients in the TEM group (p = 0.40). Mean tumor size was 64.6 ± 57.9 mm in the ESD group and 43.9 ± 30.7 mm in the TEM group (p = 0.13). Two patients in the TEM group and one patient in the ESD group had a local recurrence. The mean procedure time was 133 ± 94.8 min in the ESD group and 150 ± 66.3 min in the TEM group (p = 0.69). Mean hospital stay was 3.8 ± 3.3 days in the ESD group and 4.08 ± 1.7 days in the TEM group (p = 0.81). LIMITATIONS: This was a non-randomized clinical trial with a small sample size and selection bias in treatment options. CONCLUSION: ESD and TEM are both safe and effective for the treatment of early rectal cancer.
	PMID: 24232053 [PubMed - indexed for MEDLINE]
	Related citations

5.	Surg Endosc. 2014 Apr;28(4):1136-40. doi: 10.1007/s00464-013-3290-z. Epub 2013 Oct 30. Transanal endoscopic microsurgery after endoscopic resection of malignant rectal polyps: a useful technique for indication to radical treatment. Arolfo S¹, Allaix ME, Migliore M, Cravero F, Arezzo A, Morino M. Author information: ¹Department of Surgical Sciences, University of Torino, Corso A. M. Dogliotti 14, 10126, Turin, Italy, simone...@tiscali.it. Abstract BACKGROUND: Management of malignant rectal polyps (MRPs) after endoscopic polypectomy (EP) is still debated. It is sometimes difficult to decide whether to simply follow-up (FU) or to treat such a removed lesion. Transanal endoscopic microsurgery (TEM) could have a role both in T staging and in treating MRPs after EP. METHODS: Patients who underwent a full-thickness TEM within 3 months after an EP between January 2008 and October 2012 were retrospectively analyzed. If post-TEM histology showed locally advanced rectal cancer, patients underwent a total mesorectal excision (TME) within 4-6 weeks. Patients without malignant disease or pT1sm1 cancers at post-TEM histology were followed up every 3 months for 2 years with clinical examination, flexible rectal endoscopy, and neoplastic markers monitoring. RESULTS: A total of 39 patients were included. Post-EP histology was adenocarcinoma in 27/39 cases (69.2 %) and adenoma in 12/39. Mean operative time was 64.2 min; no 30-day mortality occurred; 30-day morbidity was 2.7 % (rectal bleeding in 1/39 cases). Post-TEM histology showed a T2 cancer in 5/39 patients, four with and one without a previous cancer diagnosis, who were further treated by TME (four RARs and one APR) and are disease free with a mean FU of 24.2 months. Post-TEM histology showed adenoma in 10/39 cases and fibrosis in 24/39. These patients are disease free with a mean FU of 13 months. CONCLUSIONS: A full-thickness TEM after EP of MRPs can establish the presence of residual malignant disease and its depth of invasion, precisely defining the indication to TME. In event of benign post-EP histology, TEM must be performed in presence of macroscopic residual disease, in order to obtain an RO resection and finally exclude cancer, while, in absence of macroscopic residual disease, only close FU is required.
	PMID: 24170069 [PubMed - indexed for MEDLINE]
	Related citations

6.	Surg Endosc. 2014 Jan;28(1):271-80. doi: 10.1007/s00464-013-3184-0. Epub 2013 Sep 6. Transanal single-port microsurgery for rectal tumors: minimal invasive surgery under spinal anesthesia. Lee TG¹, Lee SJ. Author information: ¹Department of Surgery, College of Medicine, Chungbuk National University, 52 Naesudong-ro, Heungdeok-gu, Cheongju, 361-763, Chungbuk, South Korea, nine...@hanmail.net. Abstract BACKGROUND: Transanal minimally invasive surgery (TAMIS) for rectal tumors has been introduced as an alternative approach to transanal endoscopic microsurgery (TEM). TEM has some limitations, such as the need for special equipment, expensive cost, and steep learning curve. In this study, we address the technical feasibility of TAMIS under spinal anesthesia and its short-term postoperative outcomes. METHODS: From July 2011 to September 2012, 25 consecutive patients with middle or upper third rectal masses underwent TAMIS. Tumors were located 6-17 cm from the anal verge. After spinal anesthesia, a single-incision laparoscopic surgery port was inserted into the anal canal. With this access, conventional laparoscopic instruments, including a grasper and monopolar electrocautery and suction device, were used to perform the transanal excision. A hook-type monopolar electrocautery or harmonic scalpel was used for dissection. The defect of the rectum was closed by interrupted sutures. Data concerning demographics, details of operative procedure, postoperative pain, and pathologic results were collected prospectively. To evaluate anal sphincter injury, an endoanal ultrasonography and fecal incontinence severity index survey were performed at 3-6 months after the operation. RESULTS: Of the 25 patients, nine had adenocarcinomas, nine had neuroendocrine tumors, three had tubular adenomas with high-grade dysplasia, three had tubular adenomas, one had a tubulovillous adenoma, and one had a gastrointestinal stromal tumor. The median distance from the tumor mass to the anal verge was 9.0 (range 6-17) cm. The median operative time was 45.0 (range 20-120) min. All patients received TAMIS without conversion to laparoscopic resection. There were no intraoperative complications or postoperative morbidity. The median postoperative hospital stay was 3.0 (range 2-7) days. No sphincter injury was detected by endoanal ultrasonography. CONCLUSIONS: TAMIS under spinal anesthesia is a safe and feasible technique for resection of middle and upper rectal masses. Spinal anesthesia is adequate for this procedure.
	PMID: 24061623 [PubMed - indexed for MEDLINE]
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7.	Surg Endosc. 2014 Jan;28(1):193-202. doi: 10.1007/s00464-013-3155-5. Epub 2013 Sep 12. Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions. Valsdottir EB¹, Yarandi SS, Marks JH, Marks GJ. Author information: ¹Department of Colorectal Surgery, Lankenau Hospital and Institute of Medical Research, 100 Lancaster Avenue, Medical Office Building West, Suite 330, Wynnewood, PA, 19096, USA. Abstract BACKGROUND: Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter's musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years. METHODS: A prospectively maintained database of patients undergoing TEM from 1997 to 2007 was queried to identify patients to survey using the Fecal Incontinence Quality of Life Scale questionnaire, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) questionnaire version 3, and a questionnaire designed by the authors to assess satisfaction with quality of life. From a group of 86 patients, 57 (66 %) responded to the questionnaires. Patient satisfaction outcomes were determined by age, preoperative diagnosis, tumor level in the rectum, excision method, and radiation treatment. RESULTS: Most of the patients (94.7 %) preferred TEM to having a stoma. Age (p = 0.03) and nature of the lesion (p = 0.03) were the only factors that affected coping. Depression was affected only by the presence of malignancy (p = 0.001). Excision method was the only factor that significantly influenced overall lifestyle (p = 0.002). Neither tumor level (p = 0.8) nor radiation therapy (p = 0.9) affected patient satisfaction with lifestyle after TEM. The presence of malignancy (p = 0.004) and full-thickness excision (p = 0.02) were related to more problems with fecal incontinence. CONCLUSION: Satisfaction with fecal continence generally is high after TEM. Tumor level, size of tumor, and radiation therapy do not affect the level of satisfaction after TEM. Younger age and benign nature of the lesion help patients to cope better with lifestyle changes and reduce depression. Patients with submucosal excision have a significantly higher level of satisfaction.
	PMID: 24026565 [PubMed - indexed for MEDLINE]
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8.	Surg Endosc. 2014 Jan;28(1):227-34. doi: 10.1007/s00464-013-3166-2. Epub 2013 Sep 4. Quality-of-life impairment after endoluminal locoregional resection and laparoscopic total mesorectal excision. Lezoche E¹, Paganini AM, Fabiani B, Balla A, Vestri A, Pescatori L, Scoglio D, D'Ambrosio G, Lezoche G. Author information: ¹Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Azienda Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. Abstract BACKGROUND: For selected patients with rectal cancer, endoluminal locoregional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Few data are available on quality of life (QoL) after LTME and TEM. This study aimed to compare short- and medium-term QoL for T1 rectal cancer patients undergoing LTME or ELRR by TEM. METHODS: This study investigated 35 patients with T1N0 rectal cancer who underwent TEM (n = 17) or LTME (n = 18). Quality of life was evaluated by European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-C38 questionnaires preoperatively and then 1, 6, and 12 months after surgery. RESULTS: Observation 1 month after LTME showed worsening in all items of both questionnaires. After ELRR, the QLQ-CR38 showed worsening of gastrointestinal (p = 0.005) and defecation problems (p = 0.001), and the QLQ-C30 showed worsening of global health status (p = 0.014), physical functioning (p = 0.02) role functioning (p = 0.003), fatigue (p = 0.002), and pain (p = 0.001). The QLQ-CR38 6 months after LTME showed worsening of body image (p = 0.009), micturition (p = 0.035), and gastrointestinal problems (p = 0.011), and the QLQ-C30 showed worsening of physical functioning (p = 0.003), role functioning (p = 0.002), fatigue (p = 0.004), and nausea/vomiting (p = 0.030). After ELRR, neither the QLQ-CR38 nor the QLQ-C30 questionnaire showed any worsening but demonstrated improvement in global health status and physical functioning. The QLQ-CR38 12 months after LTME showed significant improvement in defecation problems (p = 0.004) and weight loss (p = 0.003), and the QLQ-C30 showed significant improvement in global health status (p = 0.001), nausea and vomiting (p = 0.003), and pain (p = 0.005). After ELRR, the QLQ-C30 showed improvement in emotional functioning (p = 0.012), whereas no significant difference was observed by the QLQ-C38. CONCLUSIONS: Functional sequelae are present up to 1 month only after ELRR by TEM and up to 6 months after LTME. At 12 months, neither procedure showed a significant difference in QoL compared with preoperative status.
	PMID: 24002918 [PubMed - indexed for MEDLINE]
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9.	Tech Coloproctol. 2014 Feb;18(2):157-64. doi: 10.1007/s10151-013-1040-9. Epub 2013 Jun 28. Atypical indications for transanal endoscopic microsurgery to avoid major surgery. Serra-Aracil X¹, Mora-Lopez L, Alcantara-Moral M, Corredera-Cantarin C, Gomez-Diaz C, Navarro-Soto S. Author information: ¹Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Autonomous University of Barcelona, 08208, Sabadell, Barcelona, Spain, jse...@tauli.cat. Abstract BACKGROUND: Transanal endoscopic microsurgery (TEM) was originally designed for the removal of rectal tumors, principally incipient adenomas, and adenocarcinomas up to 20 cm from the anal verge. However, with the evolution of the technique and the increase in surgeons' experience, new indications have emerged and TEM may now be used in place of other surgical procedures which are associated with higher morbidity. The aim of our study was to evaluate our group's use of TEM or transanal endoscopic operations (TEO) for conditions other than rectal tumors. METHODS: An observational study of TEM (using Wolf equipment) or TEO (using Storz equipment) for indications other than excision of rectal tumors was conducted from June 2004 to July 2012. RESULTS: Four hundred twenty-four procedures were performed using TEM/TEO: removal of adenocarcinomas in 148 (34.9 %) patients, adenomas in 236 (55.7 %), post-polypectomy excision in 12 (2.8 %), removal of neuroendocrine tumors in 8 (1.9 %), and atypical indications in 20 (4.7 %). Atypical indications were pelvic abscess (3), benign rectal stenoses (2), rectourethral fistula after prostatectomy (3), gastrointestinal stromal tumor (3), endorectal condylomata acuminata (1), rectal prolapse (2), extraction of impacted fecaloma in the rectosigmoid junction (1), repair of traumatic and iatrogenic perforation of the rectum (2), and presacral tumor (3). CONCLUSIONS: The use of TEM/TEO in atypical indications may benefit patients by avoiding surgical procedures associated with greater morbidity.
	PMID: 23813055 [PubMed - indexed for MEDLINE]
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