Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2023; 15(11): 2406-2412
Published online Nov 27, 2023. doi: 10.4240/wjgs.v15.i11.2406
Trans-anal endoscopic microsurgery for non- adenomatous rectal lesions
Dafna Shilo Yaacobi, Eliahu Y Bekhor, Muhammad Khalifa, Tal E Sandler, Nidal Issa
Dafna Shilo Yaacobi, Department of Plastic Surgery and Burns, Rabin Medical Center, Petah Tikva 4941492, Israel
Eliahu Y Bekhor, Muhammad Khalifa, Nidal Issa, Department of Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel
Tal E Sandler, Department of Anesthesiology, Rabin Medical Center, Petah Tikva 4941492, Israel
Author contributions: Shilo Yaacobi D contributed to methodology, original draft preparation, and manuscript review and editing; Bekhor EY contributed to investigation, statistics, and manuscript review and editing; Khalifa M contributed to original draft preparation and manuscript review and editing; Sandler TE contributed to investigation and statistics; Issa N contributed to project administration, methodology, original draft preparation, and manuscript review and editing.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: Author declare that the authors has received a waiver from informed consent by the Institutional review board, as detailed in the attached Hebrew document.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at dafna.yaacobi@icloud.com.
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 and Burns, Rabin Medical Center, No. 39 Zabutinsky St, Petah Tikva 4941492, Israel. dafna.yaacobi@icloud.com
Received: July 18, 2023
Peer-review started: July 18, 2023
First decision: September 19, 2023
Revised: September 29, 2023
Accepted: October 29, 2023
Article in press: October 29, 2023
Published online: November 27, 2023
Processing time: 131 Days and 22.8 Hours
Abstract
BACKGROUND

Trans-anal endoscopic microsurgery (TEM) enables a good visualization of the surgical field and is considered the method of choice for excision of adenomas and early T1 rectal cancer. The rectum and retro-rectal space might be the origin of uncommon neoplasms, benign and aggressive, certain require radical trans-abdominal surgery, while others can be treated by a less aggressive approach. In this study we report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years.

AIM

To report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years.

METHODS

Between January 2008 to December 2019 a retrospective analysis was completed for all patients who underwent TEM for non-adenomatous rectal lesion or retro-rectal mass in our institution. Patients were discharged once diet was well tolerated and no complications were identified. They were evaluated at 3 wk post operatively, then at 3-mo intervals for the first 2 years and every 6 mo depending on the nature of the final pathology. Clinical examination and rectoscopy were performed during each of the follow-up visits.

RESULTS

Out of 198 patients who underwent TEM during the study period, 18 had non-adenomatous rectal or retro-rectal lesions. Mean age was 47 years. The mean size of the lesions was 2.9 mm, with a mean distance from the anal margin of 7.9 cm. Mean surgical time was 97.8 min. There were no intra-operative neither late post-operative complications. Mean length of stay was 2.5 d. Mean patient follow-up duration was 42 mo.

CONCLUSION

TEM allows for reduced morbidity given its minimally invasive nature. Surgeons should be familiar with the technique but careful patient selection should be considered. It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes. We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.

Keywords: Trans-anal endoscopic microsurgery; Rectal lesions; MicrosurgeryTrans-anal endoscopic microsurgery; Rectal lesions; Microsurgery

Core Tip: Trans-anal endoscopic microsurgery allows for reduced morbidity given its minimally invasive nature. Surgeons should be familiar with the technique but careful patient selection should be considered. It can be used safely for uncommon rectal and selected retro-rectal lesions without compromising outcomes. We believe that it should be reasonably considered as one of the surgical methods when treating rare lesions.