Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal

Xavier Serra-Aracil; Victoria Lucas-Guerrero; Laura Mora-López

doi:10.1055/s-0041-1742113

Clinics in Colon and Rectal Surgery, Table of Contents

Clin Colon Rectal Surg 2022; 35(02): 129-134
DOI: 10.1055/s-0041-1742113

Review Article

Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal

Xavier Serra-Aracil

¹Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

,

Victoria Lucas-Guerrero

¹Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

,

Laura Mora-López

¹Division of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

› Author Affiliations

Abstract

Transanal endoscopic microsurgery (TEM) allows the local excision of rectal tumors and achieves lower morbidity and mortality rates than total mesorectal excision. TEM can treat lesions up to 18 to 20 cm from the anal verge, obtaining good oncological results in T1 stage cancers and preserving sphincter function. TEM is technically demanding. Large lesions (>5 cm), those with high risk of perforation into the peritoneal cavity, those in the upper rectum or the rectosigmoid junction, and those in the anal canal are specially challenging. Primary suture after peritoneal perforation during TEM is safe and it does not necessarily require the creation of a protective stoma. We recommend closing the wall defect in all cases to avoid the risk of inadvertent perforation. It is important to identify these complex lesions promptly to transfer them to reference centers. This article summarizes complex procedures in TEM.

Keywords

TEM - TEO - TAMIS - complex lesions by TEM

Full Text

References

References
1 Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Transanal endoscopic microsurgery [in German]. Leber Magen Darm 1985; 15 (06) 271-279
2 Benson III AB, Venook AP, Cederquist L. et al. Colon cancer, version 1.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15 (03) 370-398
3 Thompson EV, Bleier JIS. Transanal minimally invasive surgery. Clin Colon Rectal Surg 2017; 30 (02) 112-119
4 Jones HJS, Hompes R, Mortensen N, Cunningham C. Modern management of T1 rectal cancer by transanal endoscopic microsurgery: a 10-year single-centre experience. Colorectal Dis 2018; 20 (07) 586-592
5 Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1986; 1 (8496): 1479-1482
6 Barendse RM, van den Broek FJ, Dekker E. et al. Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy 2011; 43 (11) 941-949
7 Serra-Aracil X, Labró-Ciurans M, Rebasa P. et al. Morbidity after transanal endoscopic microsurgery: risk factors for postoperative complications and the design of a 1-day surgery program. Surg Endosc 2019; 33 (05) 1508-1517
8 Lu JY, Lin GL, Qiu HZ, Xiao Y, Wu B, Zhou JL. Comparison of transanal endoscopic microsurgery and total mesorectal excision in the treatment of T1 rectal cancer: a meta-analysis. PLoS One 2015; 10 (10) e0141427
9 Serra-Aracil X, Ruiz-Edo N, Casalots-Casado A. et al. Importance of resection margins in the treatment of rectal adenomas by transanal endoscopic surgery. J Gastrointest Surg 2019; 23 (09) 1874-1883
10 Serra-Aracil X, Campos-Serra A, Mora-López L. et al. Is local resection of anal canal tumors feasible with transanal endoscopic surgery?. World J Surg 2020; 44 (03) 939-946
11 Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 2008; 51 (07) 1026-1030 , discussion 1030–1031
12 Serra-Aracil X, Gràcia R, Mora-López L. et al. How to deal with rectal lesions more than 15 cm from the anal verge through transanal endoscopic microsurgery. Am J Surg 2019; 217 (01) 53-58
13 Rocha JJ, Féres O. Transanal endoscopic operation: a new proposal. Acta Cir Bras 2008; 23 (Suppl. 01) 93-104 , discussion 104
14 Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 2010; 24 (09) 2200-2205
15 Serra-Aracil X, Rebasa-Cladera P, Mora-Lopez L, Pallisera-Lloveras A, Serra-Pla S, Navarro-Soto S. A scoring system to predict complex transanal endoscopic surgery. Surg Endosc 2020; 34 (11) 4828-4836
16 Serra-Aracil X, Pallisera-Lloveras A, Mora-Lopez L, Rebasa P, Serra-Pla S, Navarro S. Perforation in the peritoneal cavity during transanal endoscopic microsurgery for rectal tumors: a real surgical complication with a challenging prognosis?. Surg Endosc 2019; 33 (06) 1870-1879
17 Mege D, Petrucciani N, Maggiori L, Panis Y. Peritoneal perforation is less a complication than an expected event during transanal endoscopic microsurgery: experience from 194 consecutive cases. Tech Coloproctol 2017; 21 (09) 729-736
18 Issa N, Fenig Y, Yasin M, Schmilovitz-Weiss H, Khoury W, Powsner E. Laparoscopy following peritoneal entry during transanal endoscopic microsurgery may increase the safety and maximize the benefits of the transanal excision. Tech Coloproctol 2016; 20 (04) 221-226
19 Molina G, Bordeianou L, Shellito P, Sylla P. Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 2016; 30 (05) 1816-1825
20 Marks JH, Frenkel JL, Greenleaf CE, D'Andrea AP. Transanal endoscopic microsurgery with entrance into the peritoneal cavity: is it safe?. Dis Colon Rectum 2014; 57 (10) 1176-1182
21 Eyvazzadeh DJ, Lee JT, Madoff RD, Mellgren AF, Finne CO. Outcomes after transanal endoscopic microsurgery with intraperitoneal anastomosis. Dis Colon Rectum 2014; 57 (04) 438-441
22 Baatrup G, Borschitz T, Cunningham C, Qvist N. Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Surg Endosc 2009; 23 (12) 2680-2683
23 Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A. Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery?. Surg Endosc 2013; 27 (01) 181-188
24 Gavagan JA, Whiteford MH, Swanstrom LL. Full-thickness intraperitoneal excision by transanal endoscopic microsurgery does not increase short-term complications. Am J Surg 2004; 187 (05) 630-634
25 Ramwell A, Evans J, Bignell M, Mathias J, Simson J. The creation of a peritoneal defect in transanal endoscopic microsurgery does not increase complications. Colorectal Dis 2009; 11 (09) 964-966
26 Demartines N, von Flüe MO, Harder FH. Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 2001; 25 (07) 870-875
27 Lev-Chelouche D, Margel D, Goldman G, Rabau MJ. Transanal endoscopic microsurgery: experience with 75 rectal neoplasms. Dis Colon Rectum 2000; 43 (05) 662-667 , discussion 667–668
28 Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P. Transanal minimal invasive surgery for rectal lesions: should the defect be closed?. Colorectal Dis 2015; 17 (05) 397-402
29 Brown C, Raval MJ, Phang PT, Karimuddin AA. The surgical defect after transanal endoscopic microsurgery: open versus closed management. Surg Endosc 2017; 31 (03) 1078-1082
30 Ramirez JM, Aguilella V, Arribas D, Martinez M. Transanal full-thickness excision of rectal tumours: should the defect be sutured? A randomized controlled trial. Colorectal Dis 2002; 4 (01) 51-55
31 Serra-Aracil X, Caro-Tarrago A, Mora-López L, Casalots A, Rebasa P, Navarro-Soto S. Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum 2014; 57 (07) 823-829
32 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) 1093-1100
33 Guerrieri M, Ortenzi M, Lezoche G, Mancini S, Ghiselli R. Transanal endoscopic microsurgery in the treatment of large rectal adenomas. Minerva Chir 2016; 71 (06) 360-364
34 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 (09) 869-876
35 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 (02) 205-213
36 Maglio R, Muzi GM, Massimo MM, Masoni L. Transanal minimally invasive surgery (TAMIS): new treatment for early rectal cancer and large rectal polyps—experience of an Italian center. Am Surg 2015; 81 (03) 273-277
37 Law WL, Chu KW. Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 2004; 240 (02) 260-268
38 Whitehouse PA, Armitage JN, Tilney HS, Simson JNL. Transanal endoscopic microsurgery: local recurrence rate following resection of rectal cancer. Colorectal Dis 2008; 10 (02) 187-193
39 Serra-Aracil X, Mora-Lopez L, Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ, Navarro-Soto S. Transanal endoscopic surgery in rectal cancer. World J Gastroenterol 2014; 20 (33) 11538-11545
40 Serra-Aracil X, Mora-López L, Casalots A, Pericay C, Guerrero R, Navarro-Soto S. Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis. Surg Endosc 2016; 30 (01) 346-354
41 Sun G, Tang Y, Li X, Meng J, Liang G. Analysis of 116 cases of rectal cancer treated by transanal local excision. World J Surg Oncol 2014; 12: 202
42 Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S. A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 2014; 18 (09) 775-788
43 Slack T, Wong S, Muhlmann M. Transanal minimally invasive surgery: an initial experience. ANZ J Surg 2014; 84 (03) 177-180
44 Ragupathi M, Vande Maele D, Nieto J, Pickron TB, Haas EM. Transanal endoscopic video-assisted (TEVA) excision. Surg Endosc 2012; 26 (12) 3528-3535
45 Dulskas A, Kilius A, Petrulis K, Samalavicius NE. Transanal endoscopic microsurgery for patients with rectal tumors: a single institution's experience. Ann Coloproctol 2017; 33 (01) 23-27
46 Laliberte AS, Lebrun A, Drolet S, Bouchard P, Bouchard A. Transanal endoscopic microsurgery as an outpatient procedure is feasible and safe. Surg Endosc 2015; 29 (12) 3454-3459
47 Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 2002; 45 (02) 200-206
48 Gracia Solanas JA, Ramírez Rodríguez JM, Aguilella Diago V, Elía Guedea M, Martínez Díez M. A prospective study about functional and anatomic consequences of transanal endoscopic microsurgery. Rev Esp Enferm Dig 2006; 98 (04) 234-240
49 Mora López L, Serra-Aracil X, Navarro Soto S. Sphincter lesions observed on ultrasound after transanal endoscopic surgery. World J Gastroenterol 2015; 21 (46) 13160-13165
50 Tytherleigh MG, Warren BF, Mortensen NJM. Management of early rectal cancer. Br J Surg 2008; 95 (04) 409-423
51 Kikuchi R, Takano M, Takagi K. et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995; 38 (12) 1286-1295
52 Barendse RM, Dijkgraaf MG, Rolf UR. et al. Colorectal surgeons' learning curve of transanal endoscopic microsurgery. Surg Endosc 2013; 27 (10) 3591-3602