Long-term results of minimally invasive transanal surgery for rectal tumors in 249 consecutive patients

The Japanese journal of surgery - Tập 53 - Trang 306-315 - 2022
Kotaro Maeda1, Yoshikazu Koide2, Hidetoshi Katsuno3, Yosuke Tajima2, Tsunekazu Hanai2, Koji Masumori2, Hiroshi Matsuoka2, Miho Shiota4
1Department of Surgery, Medical Corporation Kenikukai Shonan Keiiku Hospital, Fujisawa, Japan
2Department of Surgery, Fujita Health University Hospital, Toyoake, Japan
3Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
4Department of Surgery, Kaisei Hospital, Sakaide, Japan

Tóm tắt

To delineate the long-term results of minimally invasive transanal surgery (MITAS) for selected rectal tumors. We analyzed data, retrospectively, on consecutive patients who underwent MITAS between 1995 and 2015, to establish the feasibility, excision quality, and perioperative and oncological outcomes of this procedure. MITAS was performed on 243 patients. The final histology included 142 cancers, 47 adenomas, and 52 neuroendocrine tumors (NET G1). A positive margin of 1.6% and 100% en bloc resection were achieved. The mean operative time was 27.4 min. Postoperative morbidity occurred in 7% of patients, with 0% mortality. The median follow-up was 100 months (up to ≥ 5 years or until death in 91.8% of patients). Recurrence developed in 2.9% of the patients. The 10-year overall survival rate was 100% for patients with NET G1 and 80.3% for those with cancer. The 5-year DFS was 100% for patients with Tis cancer, 90.6% for those with T1 cancer, and 87.5% for those with T2 or deeper cancers. MITAS for rectal tumors ≥ 3 cm resulted in perioperative and oncologic outcomes equivalent to those for tumors < 3 cm. MITAS is feasible for the local excision (LE) of selected rectal tumors, including tumors ≥ 3 cm. It reduces operative time and secures excision quality and long-term oncological outcomes.

Tài liệu tham khảo

You YN, Baxter NN, Stewart A, Nelson H. Is the increasing rate of local excision for stage I rectal cancer in the United States justified?: a nationwide cohort study from the National Cancer Database. Ann Surg. 2007;245:726–33. Atallah C, Taylor JP, Lo BD, Stem M, Brocke T, Efron JE, et al. Local excision for T1 rectal tumours: are we getting better? Colorectal Dis. 2020;22:2038–48. You YN, Hardiman KM, Bafford A, Poylin V, Francone TD, Davis K, et al. The American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer. Dis Colon Rectum. 2020;63:1191–222. Doornebosch PG, Tollenaar RA, De Graaf EJ. Is the increasing role of transanal Endoscopic microsurgery in curation for T1 rectal cancer justified? A Syst Rev Acta Oncol. 2009;48:343–53. Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015;58:122–40. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2018;16(7):874–901. Maeda K, Maruta M, Sato H, Hanai T, Masumori K, Matsuoka H, et al. Outcomes of novel transanal operation for selected tumors in the rectum. J Am Coll Surg. 2004;199:353–60. Lee L, Burke JP, deBeche-Adams T, Nassif G, Martin-Perez B, Monson JRT, et al. Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: Outcomes from 200 consecutive cases with midterm follow up. Ann Surg. 2018;267:910–6. Morino M, Risio M, Bach S, Beets-Tan R, Bujko K, Panis Y, et al. Early rectal cancer: the European association for endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc. 2015;29:755–73. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rodel C, Cervantes A, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017. https://doi.org/10.1093/annonc/mdx224. Van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans MW, Moons LMG, et al. Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo) radiation, or no additional treatment. Br J Surg. 2020;107:1719–30. Zinicola R, Nascimbeni R, Cirocchi R, Gagliardi G, Cracco H, Giuffrida M, et al. The impact of transanal local excision of early rectal cancer on completion rectal resection without neoadjuvant chemoradiotherapy: a systematic review. Tech Coloproctol. 2021;25:997–1010. Coton C, Lefevre JH, Debove C, Creavin B, Chafai N, Tiret E, et al. Does transanal local resection increase morbidity for subsequent total mesorectal excision for early rectal cancer? Colorectal Dis. 2019;21:15–22. Sagae VMT, Ribeiro IB, de Moura DTH, Brunaldi VO, Logiudice FP, Funari MP, et al. Endoscopic submucosal dissection versus transanal endoscopic surgery for the treatment of early rectal tumor: a systematic review and meta-analysis. Surg Endosc. 2020;34:1025–34. Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg. 2009;249:776–82. Paty PB, Nash GM, Baron P, Zakowski M, Minsky BD, Blumberg D, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002;236:522–9. Nash GM, Weiser MR, Guillem JG, Temple LK, Shia J, Gonen M, et al. Long-term survival after transanal excision of T1 rectal cancer. Dis Colon Rectum. 2009;52:577–82. Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal, appendiceal, and anal carcinoma the 3rd. English ed. J Anus Rectum Colon. 2019;3:175–95. Williams JG, Pullan RD, Hill J, Horgan PG, Salmo E, Buchanan GN, et al. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis. 2013;15:1–38. Maeda K, Maruta M, Utsumi T, Sato H, Masumori K, Koide Y. Minimally invasive transanal surgery for localized rectal carcinoid tumors. Tech Coloproctol. 2002;6:33–6. Maeda K, Hashimoto M, Nakajima K, Koh J, Yamamoto O, Hosoda Y. Transanal surgery with a new anal retractor and a stapler for tumours in the proximal rectum. Eur J Surg. 1997;163:219–21. Maeda K, Maruta M, Utsumi T, Sato H. Minimally-invasive transanal surgery (MITAS) using the F-type anal canal retractor for tumours in the lower rectum. Minim Invasive Ther Allied Technol. 2000;9:47–9. Maeda K, Hashimoto M, Katai H, Koh J, Yamamoo O, Hosoda Y. Peranal introduction of the stapler in colorectal anastomosis with a double-stapling technique. Br J Surg. 1994;81:1057. Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum. 1995;38:1286–95. Beaton C, Twine CP, Williams GL, Radcliffe AG. Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis. 2013;15:788–97. Devane LA, Burke JP, Kelly JJ, Albert M. Transanal minimally invasive surgery for rectal cancer. Ann Gastroenterol Surg. 2021;5:39–45. Baatrup G, Breum B, Qvist N, Wolle-Jorgensen P, Elbrond H, Moller P, et al. Transanal endoscopic microsurgery in 143 consecutive patients with rectal adenocarcinoma: results from a Danish multicenter study. Colorectal Dis. 2009;11:270–5. Clancy C, Burke JP, Albert MR, O’Connell PR, Winter PR. Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum. 2015;58:254–61. McCarty TR, Bazarbashi AN, Hathorn KE, Thompson CC, Aihara H. Endoscopic submucosal dissection (ESD) versus transanal endoscopic microsurgery (TEM) for treatment of rectal tumors: a comparative systematic review and meta-analysis. Surg Endosc. 2020;34:1688–95. Perivoliotis K, Baloyiannis I, Sarakatsianou C, Tzovaras G. Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis. Int J Colorectal Dis. 2020;35:1173–82. 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;72:1217–25. Arezzo A, Passera R, Saito Y, Skamoto T, Kobayashi N, Sakamoto N, et al. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc. 2014;28:427–38. 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;51:1026–30. De Graaf EJR, Burger JWA, van Ijsseldijk ALA, Tetteroo GWM, Dawson I, Hop WCJ. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis. 2011;13:762–7. Verseveld M, de Wilt JHW, Elferink MAG, de Gaaf EJR, Verhoef C, Pouwels S, et al. Survival after local excision for rectal cancer: a population-based overview of clinical practice and outcome. Acta Oncol. 2019;58:1163–6. Bentrem DJ, Okabe S, Wong WD, Weiser MR, Guillen JG, Temple LK, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg. 2005;242:472–7. Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A, et al. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum. 2005;48:1380–8. Ptok H, Marusch F, Meyer F, Schubert D, Koeckerling F, Gastinger I, et al. Oncological outcome of local vs radical resection of low-risk pT1 rectal cancer. Arch Surg. 2007;142:649–55. Althumairi AA, Gearhart SL. Local excision for early rectal cancer: transanal endoscopic microsurgery and beyond. J Gastrointest Oncol. 2015;6:296–306. Bach SP, Hill J, Monson JRT, Lane L, Marrie A, Warren B, et al. A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg. 2009;96:280–90. Madoff RD. Total mesorectal neglect in the age of total mesorectal excision. J Clin Oncol. 2013;31:4273–5. Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, et al. Exfoliated cancer cells during intersphincteric resection for very low rectal cancer. Surg Today. 2020;50:1652–6. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43:1064–71. Morino M, Allaix ME, Arolfo S, Arezzo A. Previous transanal endoscopic microsurgery for rectal cancer represents a risk factor for an increased abdominoperineal resection rate. Surg Endosc. 2013;27:3315–21. Hompes R, McDonald R, Buskens C, Lindsey I, Armitage N, Hill J, et al. Completion surgery following transanal endoscopic microsurgery: assessment of quality and short- and long-term outcome. Colorectal Dis. 2013;15:e576–81.