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Transanal Endoscopic Microsurgery Implementation in Ultra-Low Anterior Resection
Hayim Gilshtein1,2, Mariya Neymark1, Elias Manassa1
11 Department of General Surgery, Rambam Health Care Campus , Haifa, Israel .
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|October 25, 2017
Summary
Transanal endoscopic microsurgery (TEM) combined with abdominal surgery offers a viable option for low rectal cancer resection, achieving clear margins and low complication rates. This approach ensures oncological principles are maintained for better patient outcomes.
Area of Science:
- Colorectal surgery
- Surgical oncology
- Minimally invasive surgery
Background:
- Distal rectal cancer resection presents significant surgical challenges.
- Transanal platforms have emerged to improve visualization and resection of rectal tumors.
- Initial implementation of transanal platforms can involve a steep learning curve and complications.
Purpose of the Study:
- To evaluate the efficacy and safety of a combined abdominal and transanal endoscopic microsurgery (TEM) approach for very low rectal cancer.
- To assess distal margin involvement and complication rates in patients undergoing TEM for distal rectal cancer.
Main Methods:
- Retrospective analysis of patients with very low rectal cancer treated at a single tertiary center.
- Utilized a combined abdominal and transanal endoscopic microsurgery (TEM) surgical approach.
- Collected demographic, pathological, and surgical data, focusing on distal margin status.
Main Results:
- Nineteen patients underwent the combined approach during the study period.
- All patients achieved negative distal resection margins.
- Low rates of distant metastasis and local recurrence were observed with a mean follow-up of 2 years, alongside a low complication rate.
Conclusions:
- The combined transabdominal and transanal TEM approach is a feasible and effective option for resecting low rectal cancer, particularly in patients responding well to neoadjuvant therapy.
- TEM facilitates clear visualization of the distal rectum, ensuring free distal resection margins and maintaining oncological principles.
- This technique offers a low complication rate and is a valuable addition to the colorectal surgeon's armamentarium for managing distal rectal cancers.
