Trans-anal minimally invasive surgery (TAMIS) versus trans-anal endoscopic microsurgery (TEM): a comparative case–control matched-pairs analysis
Tóm tắt
Since its introduction, transanal endoscopic microsurgery (TEM) has become the treatment of choice for rectal benign lesions not amenable to flexible endoscopic excision and for early rectal cancer. Disposable soft devices as the Trans-anal Minimally Invasive Surgery (TAMIS) are a valid alternative to non-disposable rigid trans-anal endoscopic microsurgery (TEM) platforms. The aim of the present study is to compare TEM and TAMIS in terms of incidence of R1 resection and lesion fragmentation which were combined in a composite outcome called quality resection. Perioperative complication and operative time were also investigated. A total of 132 patients were eligible for this study of whom 63 (47.7%) underwent TAMIS and 69 (52.3%) underwent TEM. Patients were extracted for from a prospective maintained database and groups resulted homogenous after matching using propensity score in terms of size of the lesion, height from the anal verge, position within the rectal lumen, preoperative histology, neoadjuvant treatment. A multivariate logistic and linear regression analysis was carried out using those variables that have significant independent relationship with the quality of surgical resection and operative time. The incidence of R0 resection and lesion fragmentation was similar between groups. No differences were found in terms of perioperative complication. TAMIS was associated with less setup time and less operative time compared with TEM. Variables influencing quality resection at the multivariate analysis were larger lesion (> 5 cm) and ≥ T2 stage. Variables influencing operative time were surgical procedure (TEM vs TAMIS), height from the anal verge and size of the lesion. The present study shows that TEM and TAMIS are equally effective in terms of quality of local excision and perioperative complication. TAMIS resulted less operative time consuming compared to TEM.
Tài liệu tham khảo
Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasm and early-stage rectal cancer: efficacy and outcome in the first 50 patients. Dis Colon Recrtum 56:301–307
Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788
Clancy C, Burke JP, Albert MR, O’Connel PR (2015) Winter DC transanal endoscopic microsurgery versus standard transanal excision of rectal neoplasm: a systematic review and meta-analysis. Dis Colon rectum 58:254–261
Buess G, Hutterer F, Theiss J, Böbel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680
Buess G (1993) Transanal endoscopic microsurgery (TEM). J R Coll Surg Edinb 38:239–245
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205
Mege D, Bridoux V, Maggiori L, Tuech JJ, Panis Y (2016) What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and a disposable material. Int J Colorectal Dis. 32:1041–1045
Molina G, Bordeianou L, Shellito P, Sylla P (2016) Transanal endoscopic resection with peritoneal entry: a word of caution. Surg Endosc 30:1816–1825
Wisam K, Hayim G, Dmitri N, Yoram K, Simon-Daniel D (2013) Repeated transanal endoscopic microsurgery is feasible and safe. J Laparoendosc Adv Surg Tech A 23(3):216–219
Lee L et al (2018) Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg 267:910–916
Melin AA, Kalaskar S, Taylor L, Thompson JS, Ternent C, Langenfeld SJ (2016) Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior? Am J Surg. 212:1063–1067
Mege D, Bridoux V, Maggiori L, Tuech JJ, Panis Y (2017) What is the best tool for transanal endoscopic microsurgery (TEM)? A case-matched study in 74 patients comparing a standard platform and a disposable material. Int J Colorectal Dis. 32:1041–1045
Lee L et al (2017) Quality of local excision for rectal neoplasm using transanal endoscopic microsurgery versus trans-anal minimally invasive surgery: a multi-institutional matched analysis. Dis Colon Rectum 60:928–935
National comprehensive cancer networ (NCCN). NCCN clinical practice guideline in oncology (NCCN guidelines). Rectal cancer (Accessed on 31 May, 2016)
Saget A et al (2015) Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indication among 168 consecutive patients. Colorectal Dis 17:O155–O160
Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P (2015) Transanal minimal invasive surgery for rectal lesions: should the defect be closed? Colorectal Dis 17:397–402
Brown CJ et al (2019) A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery. Colorectal Dis 21:1025–1031
Maya A et al (2014) Learning curve for transanal endoscopic microsurgery: a single-center experience. Surg Endosc 28:1047–1412
Helewa RM et al (2016) The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance. Colorectal Dis. 18:1057–1062
Raimonda R, Arezzo A et al (2013) TransAnal minimally invasive surgery (TAMIS) with SILSTMport versus transanal endoscopic microsurgery (TEM): a comparative experimental study. Surg Endosc 27:3762–3768
Bislenghi G et al (2014) AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol 19:43–45
Banerjee AK, Jehle EC, Kreis ME, Schott UG, Claussen CD, Becker HD, Starlinger M, Buess GF (1996) Prospective study of the proctographic and functional consequences of transanal endoscopic microsurgery. Br J Surg 83:211–213
Hemingway D, Flett M, McKee RF, Finlay IG (1996) Sphincter function after transanal endoscopic microsurgical excision of rectal tumours. Br J Surg 83(1):51–52
Herman RM, Richter P, Walega P, Popiela T (2001) Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery. Int J Colorectal Dis 16(6):370–376