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A scoring system to predict complex transanal endoscopic surgery.

X Serra-Aracil1, P Rebasa-Cladera2, L Mora-Lopez2

  • 1Unidad de Coloproctología, Servicio de Cirugía General y del Ap. Digestivo, Parc Tauli Hospital Universitari. Institut d'investigació i innovació Parc Tauli I3PT, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain. xserraa@gmail.com.

Surgical Endoscopy
|November 20, 2019
PubMed
Summary
This summary is machine-generated.

Transanal endoscopic surgery (TEM) complexity varies. This study identified predictors like male sex, large tumor size, recurrence, and tumor height to differentiate simple from complex TEM procedures, guiding patient referral.

Keywords:
Learning curveTEMTEOTransanal endoscopic surgery

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Minimally Invasive Procedures

Background:

  • Transanal endoscopic surgery (TEM) is increasingly used for colorectal cancer screening.
  • Technical difficulty in TEM procedures varies significantly.
  • Existing studies on the TEM learning curve yield inconsistent results.

Purpose of the Study:

  • To differentiate between straightforward and complex transanal endoscopic surgery (TEM) procedures.
  • To establish a predictive model for TEM complexity.
  • To facilitate referral of complex cases to experienced centers.

Main Methods:

  • Prospective data collection and retrospective analysis of TEMs performed on rectal tumors (June 2004 - January 2019).
  • Procedure complexity defined by weighted mean surgical time per surgeon.
  • A predictive complexity model developed, with a score >5 indicating a complex lesion.

Main Results:

  • Out of 773 TEMs, 708 met inclusion criteria; 103 tumors were classified as complex.
  • Predictors for complexity included male sex (score 1), tumor size >5 cm (score 4), TEM for recurrence (score 5), and tumor height >15 cm from anal verge (score 1).
  • A complexity score >5 identified complex lesions.

Conclusions:

  • Differentiating simple from complex TEMs is crucial, rather than relying solely on the number of procedures performed.
  • Surgical difficulty, not just procedural volume, should define the learning curve in TEM.
  • Accurate complexity assessment aids in appropriate case management and referral.