Shilo Yaacobi D, Berger Y, Shaltiel T, Bekhor EY, Khalifa M, Issa N. Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age. World J Gastrointest Surg 2023; 15(9): 1892-1900 [PMID: 37901725 DOI: 10.4240/wjgs.v15.i9.1892]
Corresponding Author of This Article
Dafna Shilo Yaacobi, MD, Surgeon, Department of Plastic Surgery & Burns, Rabin Medical Center, No. 39 Zabutinsky Street, Petah Tikva 4941492, Israel. dafna.yaacobi@icloud.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Gastrointest Surg. Sep 27, 2023; 15(9): 1892-1900 Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.1892
Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age
Dafna Shilo Yaacobi, Yael Berger, Tali Shaltiel, Eliahu Y Bekhor, Muhammad Khalifa, Nidal Issa
Dafna Shilo Yaacobi, Department of Plastic Surgery & Burns, Rabin Medical Center, Petah Tikva 4941492, Israel
Yael Berger, Tali Shaltiel, Eliahu Y Bekhor, Muhammad Khalifa, Nidal Issa, Department of Surgery, Rabin Medical Center-Hasharon Hospital, Petah Tikva 4941492, Israel
Author contributions: Shilo Yaacobi D contributed to methodology, original draft preparation, and manuscript review and editing; Berger Y contributed to investigation and original draft preparation; Shaltiel T contributed to investigation and original draft preparation; Bekhor EY contributed to investigation, statistics, and manuscript review and editing; Khalifa M contributed to original draft preparation and manuscript review and editing; Issa N contributed to project administration, methodology, original draft preparation, and manuscript review and editing.
Institutional review board statement: This retrospective cohort study was approved by the Rabin Medical Center Institutional Review Board (Approval No. RMC-0160-18).
Informed consent statement: This retrospective cohort study was approved by the Rabin Medical Center Institutional Review Board, with a waiver of informed consent.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
Data sharing statement: The data that support the findings of this study are available from the corresponding author, DSY, upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dafna Shilo Yaacobi, MD, Surgeon, Department of Plastic Surgery & Burns, Rabin Medical Center, No. 39 Zabutinsky Street, Petah Tikva 4941492, Israel. dafna.yaacobi@icloud.com
Received: April 5, 2023 Peer-review started: April 5, 2023 First decision: June 14, 2023 Revised: June 24, 2023 Accepted: July 29, 2023 Article in press: July 29, 2023 Published online: September 27, 2023
Abstract
BACKGROUND
The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery (TEM). Local excision is an acceptable technique for high-risk and elderly patients, but there are hardly any data regarding young patients.
AIM
To describe TEM outcomes in patients under 50 years of age.
METHODS
We collected demographic, clinical, and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018.
RESULTS
During the study period, a total of 26 patients under the age of 50 years underwent TEM procedures. Their mean age was 43.3 years. Eleven (42.0%) were male. The mean operative time was 67 min, and the mean tumor size was 2.39 cm, with a mean anal verge distance of 8.50 cm. No major intraoperative or postoperative complications were recorded. The median length of stay was 2 d. Seven (26.9%) lesions were adenomas with low-grade dysplasia, four (15.4%) were high-grade dysplasia adenomas, two were T1 carcinomas (7.8%), and three were T2 carcinomas (11.5%). No residual disease was found following endoscopic polypectomy in two patients (7.8%), but four (15.4%) had other pathologies. Surgical margins were negative in all cases. Local recurrence was detected in one patient 33 mo following surgery.
CONCLUSION
Among young adult patients, TEM for benign rectal lesions has excellent outcomes. It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer. In some cases, it may be considered an alternative to radical surgery.
Core Tip: Among young adult patients, transanal endoscopic microsurgery for benign rectal lesions has excellent outcomes. It may also offer the balance between efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer and in some cases may be considered an alternative to radical surgery.
