Transanal endoscopic microsurgery (TEM) for rare rectal tumors

doi:10.3877/cma.j.issn.2095-3224.2019.06.007

Abstract

Abstract:

Objective

The purpose of this article is to discuss the application of TEM in the treatment of rare rectal tumors.

Methods

From April 2006 to May 2018, 157 patients with rare rectal tumors were treated in Peking Union Medical College Hospital. To collect clinical data and establish a retrospective and accurate database. There were 89 males and 68 females. The average diameter of the tumors was (1.2±0.7) cm, (0.2~5.3 cm) and the average distance from the anal margin was (6.6±2.3) cm, (2~12 cm). The demographic characteristics, surgical details, tumor characteristics, complications and follow-up data were analyzed.

Results

All patients were completely resected with negative incision margin. There were 3 intraoperative complications and 21 post-operative complications. Histopathological findings were reported in 114 cases of neuroendocrine tumors (NETs), thirty-five cases of gastrointestinal stromal tumors (GISTs), two cases of melanoma, two cases of lymphoma and 2 cases of leiomyoma, one case of lipoma and 1 case of squamous cell carcinoma. 145 patients were followed up for (56.25±32.13) months (19~144 months). Two patients died, one had local recurrence and one had lymph node metastasis. One case developed rectovaginal fistula one month after operation. No local recurrence, metastasis or fecal incontinence occurred in the other patients. In the analysis of neuroendocrine tumor subgroup, there was no significant difference in operation time, intraoperative bleeding and postoperative hospital stay between first operation group and the second surgery failed group. In gastrointestinal stromal tumor subgroup, there was also no significant difference between the neoadjuvant therapy group and without neoadjuvant therapy group in operation time, intraoperative bleeding and postoperative hospital stay.

Conclusion

TEM is a reliable `treatmentfor rare rectal tumors. The incidence of complications is low and the curative effect is satisfactory.

Key words: Anal canal, Rectal neoplasms, Transanal endoscopic microsurgery (TEM), Rare rectal tumors, Neuroendocrine tumors, Gastrointestinal stromal tumors, Full-thickness resection

Xueshan Bai, Guole Lin, Xin Wu, Xiaoqiang Xue, Jiaolin Zhou, Huizhong Qiu. Transanal endoscopic microsurgery (TEM) for rare rectal tumors[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 580-587.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2019.06.007

https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2019/V08/I06/580

Figures/Tables 6

References 33

[1]	Reickert CA. Uncommon colorectal neoplasms [J]. Clin Colon Rectal Surg, 2011, 24(3): 127-128.
[2]	José Errasti Alustiza, Eloy Espín Basany, ángel Reina Duarte. Rare tumors of the rectum. Narrative Review [J]. Cirugía Española, 2014, 92(9): 579-588.
[3]	Young DO, Kumar AS. Local excision of rectal cancer [J]. Surg Clin North Am,2017, 97(3): 573-585.
[4]	Buess GF, Raestrup H. Transanal endoscopic microsurgery [J]. Surg Oncol Clin N Am, 2001, 10(3): 709-731.
[5]	Ortenzi M, Ghiselli R, Cappelletti Trombettoni MM, et al. Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience [J]. World Journal of Gastrointestinal Endoscopy, 2016, 8(17):623-627.
[6]	中国抗癌协会大肠癌专业委员会TEM学组. 经肛门内镜微创手术(TEM)技术专家共识(2016) [J]. 中华胃肠外科杂志，2016，19(7)：731-733.
[7]	de Graaf EJ, Burger JW, van Ijsseldijk AL, et al. Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas [J]. Colorectal Dis, 2011, 13(7): 762-767.
[8]	林国乐，邱辉忠，周皎琳, 等. 经肛门内镜微创手术的适应证与并发症[J/CD].中华结直肠疾病电子杂志, 2015, 4(5): 63-67.
[9]	Ramwell A, Evans J, Bignell M, et al. The creation of a peritoneal defect in transanal endoscopic microsurgery does not increase complications [J]. Colorectal Disease, 2010, 11(9): 964-966.
[10]	Dulskas A, Kilius A, Petrulis K, et al. Transanal endoscopic microsurgery for patients with rectal tumors: A single institution′s experience [J]. Ann Coloproctol, 2017, 33(1): 23-27.
[11]	Gourtsoyianni S, Papanikolaou N. Role of magNETsic resonance imaging in primary rectal cancer-standard protocol and beyond [J]. Seminars in Ultrasound Ct & Mri, 2016, 37(4): 323-330.
[12]	Ishii N, Horiki N, Itoh T, et al. Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors [J]. Surgical Endoscopy, 2010, 24(6): 1413-1419.
[13]	Tsikitis VL, Wertheim BC, Guerrero MA. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: A seer analysis [J]. J Cancer, 2012, 3: 292-302.
[14]	Caplin M, Sundin A, Nillson O, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms: Colorectal neuroendocrine neoplasms [J]. Neuroendocrinology, 2012, 95(2): 88-97.
[15]	Oberg K, Akerstrom G, Rindi G, et al. Neuroendocrine gastroenteropancreatic tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up [J]. Annals of Oncology, 2010, 21(Supplement 5): v223-v227.
[16]	de Mestier L, Brixi H, Gincul R, et al. Updating the management of patients with rectal neuroendocrine tumors [J]. Endoscopy, 2013, 45(12): 1039-1046.
[17]	Shields CJ, Tiret E, Winter DC,et al. Carcinoid tumors of the rectum: A multi-institutional international collaboration [J]. Annals of Surgery, 2010, 252(5): 750-755.
[18]	Scherübl H, de Mestier L, Cadiot G. Therapy of rectal carcinoids of 11 to 19mm: A matter of debate [J]. Gastrointest Endosc, 2014, 80(3): 532-533.
[19]	Ramage JK, De Herder WW, Fave GD, et al. ENETS consensus guidelines update for colorectal neuroendocrine neoplasms [J]. Neuroendocrinology, 2016, 103(2): 139-143.
[20]	杨小云，钟芸诗，时强, 等. 改良金属夹丝线联合牵引技术在内镜治疗结直肠神经内分泌肿瘤中的应用 [J]. 中华消化内镜杂志, 2018, 35(8): 595-596.
[21]	林国乐，邱辉忠. 经肛门内镜显微手术的病例选择和手术规范[J]. 中华胃肠外科杂志, 2015, 18(5): 427-429.
[22]	Kwaan MR, Goldberg JE, Bleday R. Rectal carcinoid tumors: Review of results after endoscopic and surgical therapy [J]. Arch Surg, 2008, 143(5): 471-475.
[23]	Chen WJ, Wu N, Zhou JL, et al. Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors [J]. World J Gastroenterol, 2015, 21(30): 9142-9149.
[24]	Kirsch R, Gao ZH, Riddell R. Gastrointestinal stromal tumors: Diagnostic challenges and practical approach to differential diagnosis [J]. Adv Anat Pathol, 2007, 14(4): 261-285.
[25]	Rossi CR, Mocellin S, Mencarelli R, et al. Gastrointestinal stromal tumors: From a surgical to a molecular approach [J]. International Journal of Cancer, 2003, 107(2): 171-176.
[26]	Arezzo A, Verra M, Morinom. Transanal endoscopic microsurgery after neoadjuvant therapy for rectal GISTs [J]. Dig Liver Dis, 2011, 43(11): 923-924.
[27]	Blesius A, Cassier PA, François Bertucci, et al. Neoadjuvant imatinib in patients with locally advanced non metastatic GISTs in the prospective BFR14 trial [J]. BMC Cancer, 2011, 11(1):72.
[28]	Yasui M, Tsujinaka T, Mori M, et al. Characteristics and prognosis of rectal gastrointestinal stromal tumors: an analysis of registry data [J]. Surg Today, 2017, 47(10): 1188-1194.
[29]	Buissin D, Sterle A, Schmiegelow P, et al. Primary anorectal malignant melanoma: A rare but aggressive tumor: Report of a case [J]. World J Surg Oncol, 2015, 13(1): 1-3.
[30]	Nam S, Kim CW, Baek SJ,et al. The clinical features and optimal treatment of anorectal malignant melanoma [J]. Ann Surg Treat Res, 2014, 87(3): 113-117.
[31]	Kelley SR. Mucosa-associated lymphoid tissue (MALT) variant of primary rectal lymphoma: A review of the English literature [J]. Int J Colorectal Dis, 2017, 32(3): 295-304.
[32]	Nakamura S, Matsumoto T, Iida M, et al. Primary gastrointestinal lymphoma In Japan: a clinicopathologic analysis of 455 patients with special reference to its time trends [J]. Cancer, 2003, 97(10): 2462-2473.
[33]	Khoury W, Igov I, Issa N, et al. Transanal endoscopic microsurgery for upper rectal tumors [J]. Surg Endosc, 2014, 28(7): 2066-2071.

术中项目		统计数据
性别（男/女例）		89/68
年龄（岁，±s）		52.1±12.5
肿瘤直径（cm，±s）		1.2±0.7
距肛缘距离（cm，±s）		6.6±2.3
肿瘤位置（例）		?
?	前壁	61
?	后壁	71
?	侧壁	25
手术时间（min，±s）		60.2±20.4
术中出血量（ml，±s）		11.4±6.5
术后平均住院时间（d，±s）		2.8±1.6

术中项目		统计数据
性别（男/女例）		89/68
年龄（岁，±s）		52.1±12.5
肿瘤直径（cm，±s）		1.2±0.7
距肛缘距离（cm，±s）		6.6±2.3
肿瘤位置（例）		?
?	前壁	61
?	后壁	71
?	侧壁	25
手术时间（min，±s）		60.2±20.4
术中出血量（ml，±s）		11.4±6.5
术后平均住院时间（d，±s）		2.8±1.6

术后项目		统计数据
术后并发症（例）		21
Clavien系统分级（例）		?
?	Ⅰ级	15（发热12例、直肠出血2例、尿潴留1例）
?	Ⅱ级	4（腹泻3例、肺炎1例）
?	Ⅲ级	2（直肠出血1例、直肠阴道瘘1例）
术后住院时间（d，±s）		2.8±1.6（1~12）
随访人数（例）		145
随访时间（m，±s）		56.25±32.13（19~144）
术后复发（例）		1（鳞癌）
术后转移（例）		3（黑色素瘤2例、NETs淋巴结转移1例）

术后项目		统计数据
术后并发症（例）		21
Clavien系统分级（例）		?
?	Ⅰ级	15（发热12例、直肠出血2例、尿潴留1例）
?	Ⅱ级	4（腹泻3例、肺炎1例）
?	Ⅲ级	2（直肠出血1例、直肠阴道瘘1例）
术后住院时间（d，±s）		2.8±1.6（1~12）
随访人数（例）		145
随访时间（m，±s）		56.25±32.13（19~144）
术后复发（例）		1（鳞癌）
术后转移（例）		3（黑色素瘤2例、NETs淋巴结转移1例）

?	总数（n=114）	初次手术组（n=82）	内镜术后补救组（n=32）	t/χ²值	P值
性别（男/女）	68/46	50/32	18/14	0.152	0.833
年龄（岁）	52.37±11.81	52.29±11.75	51.81±10.92	0.209	0.835
肿瘤大小（cm）	1.02±0.48	1.03±0.48	0.81±0.21	2.791	0.006
距肛缘距离（cm）	7.41±1.83	7.38±1.81	8.03±1.84	0.838	0.404
手术时长（min）	53.51±13.65	54.69±12.87	52.71±14.91	2.405	0.018
出血量（mL）	11.64±6.12	11.71±6.11	10.85±6.72	1.886	0.062
术后住院时间（天）	2.72±1.47	2.82±1.49	2.72±1.34	0.370	0.712
侵犯深度（黏膜层/肌层/浆膜层）	43/48/8	38/36/8	5/12/0	-	-
分级（G1/G2）	70/19	55/17	15/2	-	-

Please choose a citation manager

Content to export