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
ARTICLE HIGHLIGHTS
Research background

Trans-anal endoscopic microsurgery (TEM) is a surgical method which is capable of resecting lesions up to 20 cm. It enables for excellent access, visualization of the surgical field and for precise full-thickness excision of rectal lesions.

The rectum, as well as the retro-rectal space, can be the origin of a heterogeneous group of uncommon neoplasms that range from aggressive malignancies to benign lesions that are almost always symptomatic. The treatment of this rare and heterogeneous group of lesions varies depending on the location and nature of the lesions; accordingly, certain lesions require radical trans-abdominal surgery, while others can be treated by a less aggressive approach.

Research motivation

Several studies suggest that TEM can also be an effective method for excision of uncommon lesion of the rectum and retro-rectal space.

Research objectives

The objective of this study is to report outcomes in patients undergoing TEM for rare and non-adenomatous rectal and retro-rectal lesions over a period of 11 years.

Research methods

Retrospective analysis was completed for all patients who underwent TEM procedure for non-adenomatous rectal lesion or retro-rectal mass from January 2008 to December 2019. The original Richard Wolf equipment was used to perform the procedure, and the procedure was performed according to the standard technique described specimens were pinned and marked for orientation by the surgeon. Patients resumed oral intake of liquid and soft diet on post-operative day one; with full diet being subsequently advanced, once tolerated. Patients were discharged once diet was well tolerated and no complications were identified.

Patients were evaluated at 3 wk post operatively. Follow ups were completed at 3 mo intervals for the first 2 years and then every 6 mo depending on the nature of the final pathology. Clinical examination and rectoscopy were performed during each of the followup visits.

Research results

Out of 198 patients who underwent TEM during the study period, 18 (9%) had non-adenomatous (non-carcinomas or adenomas) rectal or retro-rectal lesions. Mean age was 47 years (27–81). The mean size of the lesions described was 2.9 mm (1-6 mm), with a mean distance from the anal margin of 7.9 cm (5-13 cm). Regarding the locations of the lesions in the rectal wall; 10 lesions were in the posterior wall, 4 were in the anterior wall, 3 in lateral position, and 1 patient had circular stenosis of rectum. Mean surgical time was 97.8 min (50-200). There were no intra-operative complications. Mean length of stay was 2.5 d (1-4). No late postoperative complications were observed. The final pathologies (detailed in Table 1) of the specimens confirmed the diagnosis. Mean patient follow-up duration was 42 mo (14-80): All patients were disease free, except for the patient with the leiomyosarcoma who died due to lung metastasis at 37 mo following intervention.

Research conclusions

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

Research perspectives

Additional research is necessary, with more extensive and diverse sample size, to expand upon the findings of this study.