Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4311-4319
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4311
Transanal minimally invasive surgery vs endoscopic mucosal resection for rectal benign tumors and rectal carcinoids: A retrospective analysis
Jia-Men Shen, Jia-Ying Zhao, Tao Ye, Li-Feng Gong, Hui-Peng Wang, Wen-Jie Chen, Yuan-Kun Cai
Jia-Men Shen, Jia-Ying Zhao, Tao Ye, Li-Feng Gong, Hui-Peng Wang, Wen-Jie Chen, Yuan-Kun Cai, Department of General Surgery, Shanghai Fifth People’s Hospital, Fudan University, Shanghai 200240, China
Author contributions: Shen JM designed and performed the research and wrote the manuscript; Zhao JY and Ye T designed the research and contributed to the analysis; Gong LF, Wang HP and Chen WJ provided clinical advice; Cai YK designed the research and supervised the report.
Supported by the Science and Technology Commission of Shanghai Municipally, No. 17411967600.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the 5th People’s Hospital of Shanghai, Fudan University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yuan-Kun Cai, MD, Associate Professor, Chief Doctor, Department of General Surgery, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Road, Shanghai 200240, China. 18918168583@163.com
Received: April 4, 2020
Peer-review started: April 4, 2020
First decision: June 18, 2020
Revised: July 1, 2020
Accepted: August 29, 2020
Article in press: August 29, 2020
Published online: October 6, 2020
Processing time: 176 Days and 9.1 Hours
Abstract
BACKGROUND

Transanal minimally invasive surgery (TAMIS) is a good choice for resection of rectal neoplasms. Endoscopic mucosal resection (EMR) is also widely used in the treatment of benign rectal tumors such as rectal polyps and rectal adenomas. However, no studies have compared the outcome of TAMIS and EMR.

AIM

To compare the short-term outcomes after TAMIS and EMR for rectal carcinoid and benign tumors (including rectal polyps and adenomas).

METHODS

From January 2014 to January 2019, 44 patients who received TAMIS and 53 patients who received EMR at The Fifth People’s Hospital of Shanghai were selected. Primary outcomes (surgical-related) were operating time, blood loss, length of postoperative hospital stay, rate of resection margin involvement and lesion fragmentation rate. The secondary outcomes were complications such as hemorrhage, urinary retention, postoperative infection and reoperation.

RESULTS

No significant differences were observed in terms of blood loss (12.48 ± 8.00 mL for TAMIS vs 11.45 ± 7.82 mL for EMR, P = 0.527) and length of postoperative hospital stay (3.50 ± 1.87 d for TAMIS vs 2.72 ± 1.98 d for EMR, P = 0.065) between the two groups. Operating time was significantly shorter for EMR compared with TAMIS (21.19 ± 9.49 min vs 49.95 ± 15.28 min, P = 0.001). The lesion fragmentation rate in the EMR group was 22.6% (12/53) and was significantly higher than that (0%, 0/44) in the TAMIS group (P = 0.001). TAMIS was associated with a higher urinary retention rate (13.6%, 6/44 vs 1.9%, 1/53 P = 0.026) and lower hemorrhage rate (0%, 0/44 vs 18.9%, 10/53 P = 0.002). A significantly higher reoperation rate was observed in the EMR group (9.4%, 5/53 vs 0%, 0/44 P = 0.036).

CONCLUSION

Compared with EMR, TAMIS can remove lesions more completely with effective hemostasis and lower postoperative hemorrhage and reoperation rates. TAMIS is a better choice for the treatment of rectal carcinoids.

Keywords: Rectal neoplasms; Retrospective study; Anal canal surgery; Transanal endoscopic microsurgery/methods; Treatment outcome

Core Tip: This is a retrospective study aiming to compare the short-term outcomes of transanal minimally invasive surgery (TAMIS) and endoscopic mucosal resection (EMR) for rectal neoplasms. The surgical-related outcomes and postoperative complication rates in 44 patients who received TAMIS and 53 patients who received EMR were compared. The results showed that the EMR group was associated with longer operating time and higher lesion fragmentation rate, while the TAMIS group had lower postoperative hemorrhage and reoperation rates.