Kouladouros K.a· Baral J.b

Author affiliations

aCentral Interdisciplinary Endoscopy Department, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
bSurgery Department, Karlsruhe Municipal Hospital, Karlsruhe, Germany

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent/Cloud Rent for 48h to view Buy Cloud Access for unlimited viewing via different devices Synchronizing in the ReadCube Cloud Printing and saving restrictions apply Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: October 28, 2021
Accepted: January 28, 2022
Published online: March 04, 2022

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 3

ISSN: 2297-4725 (Print)
eISSN: 2297-475X (Online)

For additional information: https://www.karger.com/VIS

Abstract

Introduction: The resection of giant superficial neoplastic lesions of the rectum (>5 cm) is challenging even for experienced specialists. Endoscopic mucosal resection, endoscopic submucosal dissection (ESD), and transanal endoscopic microsurgery (TEM) have all been used for the treatment of such tumors. However, because of their individual disadvantages, the ideal technique for the treatment of these lesions has yet to be determined. Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) is a recently developed hybrid technique that combines the advantages of conventional TEM and flexible ESD. The aim of our study was to assess the feasibility and outcomes of TEM-ESD for the resection of giant superficial rectal neoplasms. Methods: We retrospectively analyzed all cases of TEM-ESD performed in the Department of Surgery of the Municipal Hospital of Karlsruhe between 2010 and 2020 and isolated 43 patients with superficial rectal lesions >5 cm according to the postoperative histology report. The diagnostic, perioperative, histological, and follow-up data of the patients were analyzed in the form of a retrospective, observational cohort study. Results: We identified 43 cases matching our criteria, including 35 adenomas and 8 occult adenocarcinomas. The median size of the lesions was 75 mm and the median operating time was 81.5 min. En bloc resection was possible in all cases, and histologically complete en bloc resection was confirmed in 29 cases. Five patients presented with postoperative bleeding, 2 of which were treated conservatively, 2 were treated endoscopically, and 1 required revision surgery. The median follow-up period was 15 months. There was no recurrence among patients with adenomas, 1 recurrence of a low-risk carcinoma, and 1 recurrence after the resection of a high-risk carcinoma in a patient that refused further treatment. During the follow-up period, 3 patients developed a stenosis, which was treated endoscopically. Conclusions: TEM-ESD is a feasible and safe therapeutic option for the treatment of giant superficial rectal neoplasms.

© 2022 S. Karger AG, Basel

References Jahadi MR, Baldwin A. Villous adenomas of the colon and rectum. Am J Surg. 1975;130(6):729–32. Denzer U, Beilenhoff U, Eickhoff A, Faiss S, Hüttl P, Smitten S, et al. S2k-leitlinie qualitätsanforderungen in der gastrointestinalen endoskopie, AWMF Register Nr. 021–022. Z fur Gastroenterol. 2016 ;53(12):E1–227. http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-109598. Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB. En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc. 2008 Feb;67(2):332–7. Dulskas A, Kilius A, Petrulis K, Samalavicius NE. Transanal endoscopic microsurgery for giant benign rectal tumours: is large size a contraindication?Int J Colorectal Dis. 2017;32(12):1759–61. Scala A, Gravante G, Dastur N, Sorge R, Simson JN. Transanal endoscopic microsurgery in small, large, and giant rectal adenomas. Arch Surg. 2012;147(12):1093–100. Lee EJ, Lee JB, Lee SH, Youk EG. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc. 2012;26(8):2220–30. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc. 2010;24(2):343–52. Kobayashi N, Yoshitake N, Hirahara Y, Konishi J, Saito Y, Matsuda T, et al. Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol. 2012;27(4):728–33. Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Endoscopic surgery in the rectum. Endoscopy. 1985;17(1):31–5. Allaix ME, Arezzo A, Arolfo S, Caldart M, Rebecchi F, Morino M. Transanal endoscopic microsurgery for rectal neoplasms. How i do it. J Gastrointest Surg. 2013;17(3):586–92. Kumar AS, Coralic J, Kelleher DC, Sidani S, Kolli K, Smith LE. Complications of transanal endoscopic microsurgery are rare and minor: a single institution’s analysis and comparison to existing data. Dis Colon Rectum. 2013 ;56(3):295–300. Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, et al. Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy. 2003 ;35(8):690–4. Jung DH, Youn YH, Kim JH, Park H. Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: is it feasible?Gastrointest Endosc. 2015;81(3):614–20. Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007l;66(1):100–7. Probst A, Ebigbo A, Märkl B, Schaller T, Anthuber M, Fleischmann C, et al. Endoscopic submucosal dissection for early rectal neoplasia: experience from a European center. Endoscopy. 2017 ;49(3):222–32. Wagner A, Neureiter D, Kiesslich T, Wolkersdörfer GW, Pleininger T, Mayr C, et al. Single-center implementation of endoscopic submucosal dissection (ESD) in the colorectum: low recurrence rate after intention-to-treat ESD. Dig Endosc. 2018 ;30(3):354–63. Baral J. Transanal endoscopic microsurgical submucosa dissection in the treatment of rectal adenomas and T1 rectal cancer. Coloproctology. 2018;40(5):364–72. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217–25. Tang XW, Ren YT, Zhou JQ, Wei ZJ, Chen ZY, Jiang B, et al. Endoscopic submucosal dissection for laterally spreading tumors in the rectum ≥40 mm. Tech Coloproctol. 2016;20(7):437–43. Hayashi Y, Shinozaki S, Sunada K, Sato H, Miura Y, Ino Y, et al. Efficacy and safety of endoscopic submucosal dissection for superficial colorectal tumors more than 50 mm in diameter. Gastrointest Endosc. 2016;83(3):602–7. Serra-Aracil X, Flores-Clotet R, Mora-López L, Pallisera-Lloveras A, Serra-Pla S, Navarro-Soto S. Transanal endoscopic microsurgery in very large and ultra large rectal neoplasia. Tech Coloproctol. 2019 ;23(9):869–76. Levic K, Bulut O, Hesselfeldt P. Transanal endoscopic microsurgery for giant polyps of the rectum. Tech Coloproctol. 2014 ;18(6):521–7. Mounzer R, Das A, Yen RD, Rastogi A, Bansal A, Hosford L, et al. Endoscopic and surgical treatment of malignant colorectal polyps: a population-based comparative study. Gastrointest Endosc. 2015 ;81(3):733–40.e2. Uraoka T, Kato J, Ishikawa S, Harada K, Kuriyama M, Takemoto K, et al. Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc. 2007 ;66(4):836–9. Motohashi O. Two-point fixed endoscopic submucosal dissection in rectal tumor (with video). Gastrointest Endosc. 2011 ;74(5):1132–6. Yamasaki Y, Takeuchi Y, Uedo N, Kanesaka T, Kato M, Hamada K, et al. Efficacy of traction-assisted colorectal endoscopic submucosal dissection using a clip-and-thread technique: a prospective randomized study. Dig Endosc. 2018;30(4):467–76. Nakadoi K, Tanaka S, Hayashi N, Ozawa SI, Terasaki M, Takata S, et al. Clinical outcomes of endoscopic submucosal dissection for rectal tumor close to the dentate line. Gastrointest Endosc. 2012;76(2):444–50. Schäfer H, Baldus SE, Hölscher AH. Giant adenomas of the rectum: complete resection by transanal endoscopic microsurgery (TEM). Int J Colorectal Dis. 2006 ;21(6):533–7. Kaku E, Oda Y, Murakami Y, Goto H, Tanaka T, Hasuda K, et al. Proportion of flat- and depressed-type and laterally spreading tumor among advanced colorectal neoplasia. Clin Gastroenterol Hepatol. 2011;9(6):503–8. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66(5):966–73. Niimi K, Fujishiro M, Kodashima S, Goto O, Ono S, Hirano K, et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2010;42(9):723–9. Isomoto H, Nishiyama H, Yamaguchi N, Fukuda E, Ishii H, Ikeda K, et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2009;41(8):679–83. Khoury R, Duek SD, Issa N, Khoury W. Transanal endoscopic microsurgery for large benign rectal tumors; where are the limits?Int J Surg. 2016 ;29:128–31. Ohara Y, Toyonaga T, Tanaka S, Ishida T, Hoshi N, Yoshizaki T, et al. Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms. Endoscopy. 2016;48(1):62–70. Arezzo A, Arolfo S, Allaix ME, Bullano A, Miegge A, Marola S, et al. Transanal endoscopic microsurgery for giant circumferential rectal adenomas. Colorectal Dis. 2016;18(9):897–902. Kouladouros K, Warkentin V, Kähler G. Transanal endoscopic microsurgical submucosal dissection: are there advantages over conventional ESD? Minim Invasive Ther Allied Technol. 2021:1–8. Article / Publication Details

First-Page Preview

Received: October 28, 2021
Accepted: January 28, 2022
Published online: March 04, 2022

Number of Print Pages: 6
Number of Figures: 0
Number of Tables: 3

ISSN: 2297-4725 (Print)
eISSN: 2297-475X (Online)

For additional information: https://www.karger.com/VIS

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.