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DOI: 10.1055/a-2503-1815
Transanal endoscopic cooperative surgery as a less invasive resection technique for anorectal tumors extending beyond the dentate line: Case series

Abstract
Endoscopic submucosal dissection (ESD) and surgical local excision pose particular challenges for anorectal tumors extending beyond the dentate line, making technique selection difficult. We hypothesized that combining ESD and local excision (transanal endoscopy cooperative surgery; TaECS) can effectively resect such tumors. TaECS was performed for three patients with anorectal tumors extending beyond the dentate line between January and December 2022. TaECS was indicated for local resection of tumors extending beyond the dentate line with a low risk of lymph node metastases. TaECS was performed in an operating room after ensuring adequate bowel preparation. The oral side of the tumor was dissected endoscopically with resection margins precisely evaluated using magnifying endoscopy. The anal side was surgically dissected above the internal anal sphincter. The defect was repaired wtih bilateral V-Y advancement flap reconstruction. All three tumors were successfully resected in en bloc fashion without intraprocedural adverse events. No postoperative stricture and bleeding occurred. A postoperative abscess around the anastomosis was observed in one case. The anal sphincter was preserved in all cases. No recurrences were recorded at the 17- to 27-month follow-up. TaECS may be a viable treatment for minimally invasive local resection of anorectal tumors extending beyond the dentate line.
Keywords
Endoscopy Lower GI Tract - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Polyps / adenomas / ... - Colorectal cancer - Quality and logistical aspects - Performance and complicationsPublication History
Received: 08 July 2024
Accepted after revision: 19 November 2024
Accepted Manuscript online:
16 December 2024
Article published online:
29 January 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Kohei Shigeta, Kazunori Takada, Kinichi Hotta, Kenichiro Imai, Sayo Ito, Junya Sato, Yoichi Yamamoto, Masao Yoshida, Yuki Maeda, Noboru Kawata, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Akio Shiomi, Hiroyasu Kagawa, Manabe Shoichi, Yusuke Yamaoka, Shunsuke Kasai, Yusuke Tanaka, Yasuyuki Hirashima, Ayako Mochizuki, Shusuke Yoshikawa, Arata Tsutsumida, Wataru Omata, Takuma Oishi, Hiroyuki Ono. Transanal endoscopic cooperative surgery as a less invasive resection technique for anorectal tumors extending beyond the dentate line: Case series. Endosc Int Open 2025; 13: a25031815.
DOI: 10.1055/a-2503-1815
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