Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2016; 8(17): 623-627
Published online Sep 16, 2016. doi: 10.4253/wjge.v8.i17.623
Transanal endoscopic microsurgery as optimal option in treatment of rare rectal lesions: A single centre experience
Monica Ortenzi, Roberto Ghiselli, Maria Michela Cappelletti Trombettoni, Luca Cardinali, Mario Guerrieri
Monica Ortenzi, Roberto Ghiselli, Maria Michela Cappelletti Trombettoni, Luca Cardinali, Mario Guerrieri, Department of General Surgery, Università Politecnica delle Marche, 60126 Ancona, Italy
Author contributions: Ortenzi M and Ghiselli R designed the study; Ortenzi M, Cappelletti Trombettoni MM and Cardinali L contributed to acquisition of data and drafting the article; Guerrieri M approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Ospedali Riuniti Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No financial support or incentive has been provided for this manuscript. All authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: Technical appendix, original data, and statistical code of manuscript NO 26052 submitted to World Journal of Gastrointestinal Endoscopy are available from the corresponding author at monica.ortenzi@gmail.com. Partecipants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Monica Ortenzi, Department of General Surgery, Università Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy. monica.ortenzi@gmail.com
Telephone: +39-71-5963648 Fax: +39-71-5963326
Received: March 28, 2016
Peer-review started: March 29, 2016
First decision: May 17, 2016
Revised: June 2, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: September 16, 2016
Abstract
AIM

To analyze the outcomes of transanal endoscopic microsurgery (TEM) in the treatment of rare rectal condition like mesenchymal tumors, condylomas, endometriosis and melanoma.

METHODS

We retrospectively reviewed a twenty-three years database. Fifty-two patients were enrolled in this study. The lesions were considered suitable for TEM if they were within 20 cm from the anus. All of them underwent an accurate preoperative workup consisting in clinical examination, total colonoscopy with biopsies, endoscopic ultrasonography, and pelvic computerized tomography or pelvic magnetic resonance imaging. Operative time, intraoperative complications, rate of conversion, tumor size, postoperative morbidity, mortality, the length of hospital stay, local and distant recurrence were analyzed.

RESULTS

Among the 1328 patients treated by TEM in our department, the 52 patients with rectal abnormalities other than adenoma or adenocarcinoma represented 4.4%. There were 30 males (57.7%) and 22 females (42.3%). Mean age was 55 years (median = 60, range = 24-78). This series included 14 (26.9%) gastrointestinal stromal tumors, 21 neuroendocrine tumors (40.4%), 1 ganglioneuroma (1.9%), 2 solitary ulcers in the rectum (3.8%), 6 cases of rectal endometriosis (11.5%), 6 cases of rectal condylomatosis (11.5%) and 2 rectal melanomas (3.8%). Mean lesion diameter was 2.7 cm (median: 4, range: 0.4-8). Mean distance from the anal verge was 9.5 cm (median: 10, range: 4-15). One patient operated for rectal melanoma developed distant metastases and died two years after the operation. We experienced 2 local recurrences (3.8%) with an overall survival equal to 97.6% (95%CI: 95%-99%) at the end of follow-up and a disease free survival of 98% (95%CI: 96%-99%).

CONCLUSION

We could conclude that TEM is an important therapeutical option for rectal rare conditions.

Keywords: Transanal endoscopic microsurgery, Rare rectal conditions, Full-thickness excision, Minimally invasive surgery, Retrospective study

Core tip: This paper is about the management of rare rectal lesions by transanal endoscopic microsurgery (TEM). The rarity of these conditions and the lack of big reports about this topic make this work important. We focused our attention on operative data and postoperative long-term outcomes. Our results suggested that TEM is a safe, minimally invasive procedure that can be adopted for the treatment of these conditions with excellent results.