Significance of defect closure following transanal local full‑thickness excision of rectal malignant tumors

Noura,Shingo; Ohue,Masayuki; Miyoshi,Norikatsu; Yasui,Masayoshi

doi:10.3892/mco.2016.979

Significance of defect closure following transanal local full‑thickness excision of rectal malignant tumors

Authors:
- Shingo Noura
- Masayuki Ohue
- Norikatsu Miyoshi
- Masayoshi Yasui
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Affiliations: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Osaka 537‑8511, Japan
Published online on: August 4, 2016 https://doi.org/10.3892/mco.2016.979
Pages: 449-454

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Abstract

Transanal excision (TAE) for rectal tumors is increasingly applied and it is generally recommended that the defect following full‑thickness excision should be closed. The aim of this study was to compare the complications and anal function following TAE between cases where the defect was closed and those where it was not. A total of 43 consecutive rectal malignant tumor patients eligible for TAE were investigated. Regarding anorectal function, incontinence was assessed using the Wexner score. The defect of the rectum was closed in 21 of the 43 patients. There were no significant differences between the two groups regarding gender, distance from the anal verge, tumor size, diagnosis and tumor site. There was a significantly higher number of postoperative complications of all grades and ≥Clavien‑Dindo grade IIIa in the closure group (P=0.02 and 0.04, respectively). Regarding the Wexner score, there was no significant difference between the two groups (P=0.24). Compared with the closure group, the non‑closure group had significantly fewer postoperative complications of all grades and ≥Clavien‑Dindo grade IIIa. Moreover, there was no significant difference regarding the anorectal function between the two groups. Thus, suturing the rectal defect is not necessarily recommended following TAE.

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1	Morris E, Quirke P, Thomas JD, Fairley L, Cottier B and Forman D: Unacceptable variation in abdominoperineal excision rates for rectal cancer: Time to intervene? Gut. 57:1690–1697. 2008. View Article : Google Scholar : PubMed/NCBI
2	Morino M, Parini U, Giraudo G, Salval M, Brachet Contul R and Garrone C: Laparoscopic total mesorectal excision: A consecutive series of 100 patients. Ann Surg. 237:335–342. 2003. View Article : Google Scholar : PubMed/NCBI
3	Ho P, Law WL, Chan SC, Lam CK and Chu KW: Functional outcome following low anterior resection with total mesorectal excision in the elderly. Int J Colorectal Dis. 18:230–233. 2003.PubMed/NCBI
4	Wallner C, Lange MM, Bonsing BA, Maas CP, Wallace CN, Dabhoiwala NF, Rutten HJ, Lamers WH, Deruiter MC and van de Velde CJ: Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial: Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: A study from the cooperative clinical investigators of the Dutch total mesorectal excision trial. J Clin Oncol. 26:4466–4472. 2008. View Article : Google Scholar : PubMed/NCBI
5	Buess G, Theiss R, Günther M, Hutterer F and Pichlmaier H: Endoscopic surgery in the rectum. Endoscopy. 17:31–35. 1985. View Article : Google Scholar : PubMed/NCBI
6	Moore JS, Cataldo PA, Osler T and Hyman NH: Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum. 51:1026–1030; discussion 1030-1031. 2008. View Article : Google Scholar : PubMed/NCBI
7	Casadesus D: Surgical resection of rectal adenoma: A rapid review. World J Gastroenterol. 15:3851–3854. 2009. View Article : Google Scholar : PubMed/NCBI
8	Middleton PF, Sutherland LM and Maddern GJ: Transanal endoscopic microsurgery: A systematic review. Dis Colon Rectum. 48:270–284. 2005. View Article : Google Scholar : PubMed/NCBI
9	Atallah S, Albert M and Larach S: Transanal minimally invasive surgery: A giant leap forward. Surg Endosc. 24:2200–2205. 2010. View Article : Google Scholar : PubMed/NCBI
10	MartinPerez B, AndradeRibeiro GD, Hunter L and Atallah S: A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol. 18:775–788. 2014. View Article : Google Scholar : PubMed/NCBI
11	Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B and Mortensen NJ: Association of Coloproctology of Great Britain and Ireland Transanal Endoscopic Microsurgery (TEM) Collaboration: A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg. 96:280–290. 2009. View Article : Google Scholar : PubMed/NCBI
12	Doornebosch PG, Tollenaar RA, Gosselink MP, Stassen LP, Dijkhuis CM, Schouten WR, van de Velde CJ and de Graaf EJ: Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer. Colorectal Dis. 9:553–558. 2007. View Article : Google Scholar : PubMed/NCBI
13	Gall FP and Hermanek P: Cancer of the rectum-local excision. Surg Clin North Am. 68:1353–1365. 1988. View Article : Google Scholar : PubMed/NCBI
14	Franken RJ, Moes DE, Acherman YI and Derksen EJ: Free Intra-abdominal air without peritoneal perforation after TEM: A report of two cases. Case Rep Surg. 2012:1854292012.PubMed/NCBI
15	Simkens GA, Nienhuijs SW, Luyer MD and de Hingh IH: Massive surgical emphysema following transanal endoscopic microsurgery. World J Gastrointest Surg. 6:160–163. 2014. View Article : Google Scholar : PubMed/NCBI
16	Bleday R: Local excision of rectal cancer. World J Surg. 21:706–714. 1997. View Article : Google Scholar : PubMed/NCBI
17	Lawrence MA and Goldberg SM: Local excision for selected colorectal carcinomas. Baillieres Clin Gastroenterol. 3:727–737. 1989. View Article : Google Scholar : PubMed/NCBI
18	Buess G, Mentges B, Manncke K, Starlinger M and Becker HD: Technique and results of transanal endoscopic microsurgery in early rectal cancer. Am J Surg. 163:63–69; discussion 69-70. 1992. View Article : Google Scholar : PubMed/NCBI
19	Ramirez JM, Aguilella V, Arribas D and Martinez M: Transanal full-thickness excision of rectal tumours: Should the defect be sutured? a randomized controlled trial. Colorectal Dis. 4:51–55. 2002. View Article : Google Scholar : PubMed/NCBI
20	Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D and Delrio P: Transanal minimal invasive surgery for rectal lesions: Should the defect be closed? Colorectal Dis. 17:397–402. 2015. View Article : Google Scholar : PubMed/NCBI
21	Jorge JM and Wexner SD: Etiology and management of fecal incontinence. Dis Colon Rectum. 36:77–97. 1993. View Article : Google Scholar : PubMed/NCBI
22	No authors listed: Classic articles in colonic and rectal surgery. Jacques Lisfranc 1790-1847. Observation on a cancerous condition of the rectum treated by excision. Dis Colon Rectum. 26:694–695. 1983.PubMed/NCBI
23	Parks AG: A technique for excising extensive villous papillomatous change in the lower rectum. Proc R Soc Med. 61:441–442. 1968.PubMed/NCBI
24	Lim SB, Seo SI, Lee JL, Kwak JY, Jang TY, Kim CW, Yoon YS, Yu CS and Kim JC: Feasibility of transanal minimally invasive surgery for mid-rectal lesions. Surg Endosc. 26:3127–3132. 2012. View Article : Google Scholar : PubMed/NCBI
25	Hayashi S, Takayama T, Yamagata M, Matsuda M and Masuda H: Single-incision laparoscopic surgery used to perform transanal endoscopic microsurgery (SILSTEM) for T1 rectal cancer under spinal anesthesia: Report of a case. Surg Today. 43:325–328. 2013. View Article : Google Scholar : PubMed/NCBI
26	Albert MR, Atallah SB, deBecheAdams TC, Izfar S and Larach SW: Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: Efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 56:301–307. 2013. View Article : Google Scholar : PubMed/NCBI
27	Leonard D, Remue C and Kartheuser A: The transanal endoscopic microsurgery procedure: Standards and extended indications. Dig Dis. 30(Suppl 2): S85–S90. 2012. View Article : Google Scholar
28	Bignell MB, Ramwell A, Evans JR, Dastur N and Simson JN: Complications of transanal endoscopic microsurgery (TEMS): A prospective audit. Colorectal Dis. 12:e99–e103. 2010.PubMed/NCBI
29	Ganai S, Kanumuri P, Rao RS and Alexander AI: Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol. 13:547–556. 2006. View Article : Google Scholar : PubMed/NCBI
30	Allaix ME, Arezzo A, Cassoni P, Famiglietti F and Morino M: Recurrence after transanal endoscopic microsurgery for large rectal adenomas. Surg Endosc. 26:2594–2600. 2012. View Article : Google Scholar : PubMed/NCBI
31	Marks JH, Marchionni C and Marks GJ: Transanal endoscopic microsurgery in the treatment of select rectal cancers or tumors suspicious for cancer. Surg Endosc. 17:1114–1117. 2003. View Article : Google Scholar : PubMed/NCBI
32	Ito M, Saito N, Sugito M, Kobayashi A, Nishizawa Y and Tsunoda Y: Analysis of clinical factors associated with anal function after intersphincteric resection for very low rectal cancer. Dis Colon Rectum. 52:64–70. 2009. View Article : Google Scholar : PubMed/NCBI
33	Kakodkar R, Gupta S and Nundy S: Low anterior resection with total mesorectal excision for rectal cancer: Functional assessment and factors affecting outcome. Colorectal Dis. 8:650–656. 2006. View Article : Google Scholar : PubMed/NCBI
34	Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA and Illstrup DM: The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg. 220:676–682. 1994. View Article : Google Scholar : PubMed/NCBI
35	Rimonda R, Arezzo A, Arolfo S, Salvai A and Morino M: TransAnal minimally invasive surgery (TAMIS) with SILS™ port versus transanal endoscopic microsurgery (TEM): A comparative experimental study. Surg Endosc. 27:3762–3768. 2013. View Article : Google Scholar : PubMed/NCBI