Optimization of transanal endoscopic microsurgery for resection of benign rectal tumors
DOI:
https://doi.org/10.15574/PS.2024.4(85).9398Keywords:
transanal endoscopic microsurgery, TEM, benign rectal tumors, marking, resection marginsAbstract
One of the effective methods for the surgical treatment of benign rectal tumors is transanal endoscopic microsurgery (TEM). Despite the high effectiveness of TEM in treating benign rectal tumors, recurrences are diagnosed in 3-26% of patients.
Aim - to increase the effectiveness of surgical treatment of benign rectal tumors by optimizing TEM.
Materials and methods. From 2007 to 2024, 153 patients with benign rectal tumors were operated on using TEM. The cohort included 80 men and 73 women aged 37-76 (mean age 56±20 years). Depending on the surgical method, the patients were divided into two groups. The first group - 75 patients who underwent classical TEM tumor resection. The second group - 78 patients who were operated on using an advanced TEM technique, which included preoperative marking of the mucous membrane around the tumor within healthy tissues using endoscopic refinement methods. Effectiveness control was conducted through morphological examination of the removed tumors and analysis of recurrence rates.
Results. In the first group, en-bloc tumor resection was performed in 62 (82.6%) patients, and fragmentation resection in 13 (17.4%) patients. Following en-bloc resections, R0 was achieved in 56 (90.3%) cases, and R1 in 6 (97%) patients. Local recurrence occurred in 11 (14.0%) patients. In the second group, en-bloc tumor resection was performed in 70 (89.7%) patients, and fragmentation resection in 8 (10.3%) patients. Following en-bloc resections, R0 was achieved in 69 (98.5%) cases, and R1 in one (1.5%) patient. Local recurrence was detected in 3 (3.8%) patients. In all cases of local recurrence, repeat TEM resection or endoscopic resection was performed.
Conclusions. Optimization of TEM resection for benign rectal tumors, incorporating preoperative determination of resection margins, improves treatment efficacy by 73.7% compared to the conventional technique and significantly reduces recurrence rates from 14.6% to 3.8%.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research.
The authors declare no conflict of interest.
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