BACKGROUND: Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients. METHODS: This study was designed to evaluate short-term morbidity (according to Clavien's classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study. RESULTS: Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (p = 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (p = 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (p = 0.081 and 0.288, respectively). CONCLUSIONS: TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.
BACKGROUND: Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients. METHODS: This study was designed to evaluate short-term morbidity (according to Clavien's classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study. RESULTS: Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (p = 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (p = 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (p = 0.081 and 0.288, respectively). CONCLUSIONS: TEM after RCT in selected rectal cancerpatients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.
Authors: E Kapiteijn; C A Marijnen; I D Nagtegaal; H Putter; W H Steup; T Wiggers; H J Rutten; L Pahlman; B Glimelius; J H van Krieken; J W Leer; C J van de Velde Journal: N Engl J Med Date: 2001-08-30 Impact factor: 91.245
Authors: Carlo Capirci; Vincenzo Valentini; Luca Cionini; Antonino De Paoli; Claus Rodel; Robert Glynne-Jones; Claudio Coco; Mario Romano; Giovanna Mantello; Silvia Palazzi; Falchetti Osti Mattia; Maria Luisa Friso; Domenico Genovesi; Cristiana Vidali; Maria Antonietta Gambacorta; Alberto Buffoli; Marco Lupattelli; Maria Silvia Favretto; Giuseppe La Torre Journal: Int J Radiat Oncol Biol Phys Date: 2008-04-11 Impact factor: 7.038
Authors: P Gervaz; N Rotholtz; S D Wexner; S Y You; N Saigusa; E Kaplan; M Secic; E G Weiss; J J Nogueras; B Belin Journal: Dis Colon Rectum Date: 2001-11 Impact factor: 4.585
Authors: P G Doornebosch; R A E M Tollenaar; M P Gosselink; L P Stassen; C M Dijkhuis; W R Schouten; C J van de Velde; E J R de Graaf Journal: Colorectal Dis Date: 2007-07 Impact factor: 3.788
Authors: G Lezoche; M Baldarelli; Mario Guerrieri; A M Paganini; A De Sanctis; S Bartolacci; E Lezoche Journal: Surg Endosc Date: 2007-10-18 Impact factor: 4.584
Authors: G Rizzo; D P Pafundi; F Sionne; L D'Agostino; G Pietricola; M A Gambacorta; V Valentini; C Coco Journal: Tech Coloproctol Date: 2021-01-18 Impact factor: 3.781
Authors: Giancarlo D'Ambrosio; Alessandro M Paganini; Andrea Balla; Silvia Quaresima; Pietro Ursi; Paolo Bruzzone; Andrea Picchetto; Fabrizio I Mattei; Emanuele Lezoche Journal: Surg Endosc Date: 2015-06-05 Impact factor: 4.584
Authors: Angelo Restivo; Luigi Zorcolo; Giuseppe D'Alia; Francesca Cocco; Andrea Cossu; Francesco Scintu; Giuseppe Casula Journal: Int J Colorectal Dis Date: 2015-08-23 Impact factor: 2.571
Authors: X Serra-Aracil; C Pericay; T Golda; L Mora; E Targarona; S Delgado; A Reina; F Vallribera; J M Enriquez-Navascues; S Serra-Pla; J C Garcia-Pacheco Journal: Int J Colorectal Dis Date: 2017-12-12 Impact factor: 2.571
Authors: Carlos Frederico S Marques; Caio Sergio R Nahas; Ulysses Ribeiro; Leonardo A Bustamante; Rodrigo Ambar Pinto; Eduardo Kenzo Mory; Ivan Cecconello; Sergio Carlos Nahas Journal: Int J Colorectal Dis Date: 2016-02-09 Impact factor: 2.571