Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms

doi:10.5412/wjsp.v5.i1.1

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World Journal of Surgical Procedures

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2219-2832

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Surg Proced. Mar 28, 2015; 5(1): 1-13
Published online Mar 28, 2015. doi: 10.5412/wjsp.v5.i1.1

Table 5 Appropriate indications for the use of transanal excision/transanal endoscopic microsurgery/transanal minimally invasive surgery or endoscopic mucosal resection

Category	Primary approach	Secondary or individualized approach
Benign pathology	Low rectum: TAE or TEMS Middle to high rectum: TEMS/TAMIS/EMR or LAR Proximal to rectum: EMR or L/O CR	Very large lesion: LAR
Borderline pathology	Carcinoid < 1 cm with favorable features: TEMS/TAMIS Scar after colonoscopic removal of cancerous polyp: TEMS/TAMIS Uncertain dignity: TEMS/TAMIS mucosal resection as excisional biopsy	Excisional biopsy with TEMS/TAMIS/TAE → LAR if malignant?
Malignant (Rectum)	u/pT1: LAR u/pT2: LAR u/pT3: CRT + LAR Recurrence: CRT + LAR Carcinoid > 1 cm: LAR	u/pT1 + morbidity: TAE/TEMS/TAMIS u/pT2: TAE/TEMS/TAMIS + CRT
Malignant (Colon)	pTis: EMR/polypectomy pT1: L/O CR (unless free stalk > 2 mm) > T1: L/O CR	pTis (large): L/O CR pT1 + morbidity: EMR + observation

LAR: Low anterior resection (laparoscopic, robotic, open); L/O CR: Laparoscopic vs open colon resection; TAE: Transanal excision; TAMIS: Transanal minimally invasive surgery; TEMS: Transanal endoscopic microsurgery; TME: Total mesorectal excision; EMR: Endoscopic mucosal resection.

Citation: Devaraj B, Kaiser AM. Impact of technology on indications and limitations for transanal surgical removal of rectal neoplasms. World J Surg Proced 2015; 5(1): 1-13
URL: https://www.wjgnet.com/2219-2832/full/v5/i1/1.htm
DOI: https://dx.doi.org/10.5412/wjsp.v5.i1.1