Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome
Background Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathologi...
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| Veröffentlicht in: | Surgical endoscopy 2013-08, Vol.27 (8), p.2860-2867 |
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| creator | Coco, C. Rizzo, G. Mattana, C. Gambacorta, M. A. Verbo, A. Barbaro, B. Vecchio, F. M. Pafundi, D. P. Mastromarino, M. G. Valentini, V. |
| description | Background
Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.
Methods
This study was designed to evaluate short-term morbidity (according to Clavien’s classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.
Results
Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (
p
= 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (
p
= 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (
p
= 0.081 and 0.288, respectively).
Conclusions
TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery. |
| doi_str_mv | 10.1007/s00464-013-2842-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1400398378</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3018307541</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-eb11821ba875d7e9d1005f4fbdc4f4a1ed36ccae69fdb8af8e772bbcc5c784713</originalsourceid><addsrcrecordid>eNp1kc1u1DAUhS0EotPCA7BBltiwCfgvscMOVUCRKrEp68ixrxmPkniwHdR5IN6TG01BCInVXdzvnPtzCHnB2RvOmH5bGFOdahiXjTBKNN0jsuNKikYIbh6THesla4Tu1QW5LOXAEO95-5RcCKmY4q3ckZ932S7FLnaisPhUXDpGR-focipr_gb5RG2okOkCyfrD-sMulWbrY3J7mFPdQ7bHEw0p0yk5O03Ie4QceAr3FZuQY00L4IAMrmJxWze_o2Wfcm3Qe6ZzymP0saJ48TSsi6sxbTultbo0wzPyJNipwPOHekW-fvxwd33T3H759Pn6_W3jlDS1gZFzI_hojW69ht7jl9qgwuidCspy8LJzzkLXBz8aGwxoLcbRudZpozSXV-T12feY0_cVSh3mWBxMk8Xz1zJwxZjsjdQG0Vf_oIe0ZtwZKdn3XSe0EUjxM7X9s2QIwzHH2ebTwNmwZTicMxwww2HLcOhQ8_LBeR1n8H8Uv0NDQJyBgq0FM_pr9H9dfwHZ9a0V</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1399662782</pqid></control><display><type>article</type><title>Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Coco, C. ; Rizzo, G. ; Mattana, C. ; Gambacorta, M. A. ; Verbo, A. ; Barbaro, B. ; Vecchio, F. M. ; Pafundi, D. P. ; Mastromarino, M. G. ; Valentini, V.</creator><creatorcontrib>Coco, C. ; Rizzo, G. ; Mattana, C. ; Gambacorta, M. A. ; Verbo, A. ; Barbaro, B. ; Vecchio, F. M. ; Pafundi, D. P. ; Mastromarino, M. G. ; Valentini, V.</creatorcontrib><description>Background
Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.
Methods
This study was designed to evaluate short-term morbidity (according to Clavien’s classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.
Results
Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (
p
= 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (
p
= 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (
p
= 0.081 and 0.288, respectively).
Conclusions
TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-013-2842-6</identifier><identifier>PMID: 23404153</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Cancer therapies ; Chemoradiotherapy - methods ; Colorectal cancer ; Defecation - physiology ; Endoscopy ; Fecal incontinence ; Female ; Follow-Up Studies ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Italy - epidemiology ; Male ; Medicine ; Medicine & Public Health ; Microsurgery ; Microsurgery - methods ; Middle Aged ; Morbidity ; Morbidity - trends ; Mortality ; Natural Orifice Endoscopic Surgery - methods ; Neoadjuvant Therapy ; Postoperative period ; Proctology ; Radiation therapy ; Rectal Neoplasms - epidemiology ; Rectal Neoplasms - physiopathology ; Rectal Neoplasms - therapy ; Rectum ; Retrospective Studies ; Surgery ; Surveys and Questionnaires ; Time Factors ; Tomography ; Treatment Outcome ; Ultrasonic imaging</subject><ispartof>Surgical endoscopy, 2013-08, Vol.27 (8), p.2860-2867</ispartof><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-eb11821ba875d7e9d1005f4fbdc4f4a1ed36ccae69fdb8af8e772bbcc5c784713</citedby><cites>FETCH-LOGICAL-c438t-eb11821ba875d7e9d1005f4fbdc4f4a1ed36ccae69fdb8af8e772bbcc5c784713</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-013-2842-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-013-2842-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23404153$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Coco, C.</creatorcontrib><creatorcontrib>Rizzo, G.</creatorcontrib><creatorcontrib>Mattana, C.</creatorcontrib><creatorcontrib>Gambacorta, M. A.</creatorcontrib><creatorcontrib>Verbo, A.</creatorcontrib><creatorcontrib>Barbaro, B.</creatorcontrib><creatorcontrib>Vecchio, F. M.</creatorcontrib><creatorcontrib>Pafundi, D. P.</creatorcontrib><creatorcontrib>Mastromarino, M. G.</creatorcontrib><creatorcontrib>Valentini, V.</creatorcontrib><title>Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.
Methods
This study was designed to evaluate short-term morbidity (according to Clavien’s classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.
Results
Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (
p
= 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (
p
= 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (
p
= 0.081 and 0.288, respectively).
Conclusions
TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer therapies</subject><subject>Chemoradiotherapy - methods</subject><subject>Colorectal cancer</subject><subject>Defecation - physiology</subject><subject>Endoscopy</subject><subject>Fecal incontinence</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Italy - epidemiology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Microsurgery</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Morbidity - trends</subject><subject>Mortality</subject><subject>Natural Orifice Endoscopic Surgery - methods</subject><subject>Neoadjuvant Therapy</subject><subject>Postoperative period</subject><subject>Proctology</subject><subject>Radiation therapy</subject><subject>Rectal Neoplasms - epidemiology</subject><subject>Rectal Neoplasms - physiopathology</subject><subject>Rectal Neoplasms - therapy</subject><subject>Rectum</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surveys and Questionnaires</subject><subject>Time Factors</subject><subject>Tomography</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc1u1DAUhS0EotPCA7BBltiwCfgvscMOVUCRKrEp68ixrxmPkniwHdR5IN6TG01BCInVXdzvnPtzCHnB2RvOmH5bGFOdahiXjTBKNN0jsuNKikYIbh6THesla4Tu1QW5LOXAEO95-5RcCKmY4q3ckZ932S7FLnaisPhUXDpGR-focipr_gb5RG2okOkCyfrD-sMulWbrY3J7mFPdQ7bHEw0p0yk5O03Ie4QceAr3FZuQY00L4IAMrmJxWze_o2Wfcm3Qe6ZzymP0saJ48TSsi6sxbTultbo0wzPyJNipwPOHekW-fvxwd33T3H759Pn6_W3jlDS1gZFzI_hojW69ht7jl9qgwuidCspy8LJzzkLXBz8aGwxoLcbRudZpozSXV-T12feY0_cVSh3mWBxMk8Xz1zJwxZjsjdQG0Vf_oIe0ZtwZKdn3XSe0EUjxM7X9s2QIwzHH2ebTwNmwZTicMxwww2HLcOhQ8_LBeR1n8H8Uv0NDQJyBgq0FM_pr9H9dfwHZ9a0V</recordid><startdate>20130801</startdate><enddate>20130801</enddate><creator>Coco, C.</creator><creator>Rizzo, G.</creator><creator>Mattana, C.</creator><creator>Gambacorta, M. A.</creator><creator>Verbo, A.</creator><creator>Barbaro, B.</creator><creator>Vecchio, F. M.</creator><creator>Pafundi, D. P.</creator><creator>Mastromarino, M. G.</creator><creator>Valentini, V.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20130801</creationdate><title>Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome</title><author>Coco, C. ; Rizzo, G. ; Mattana, C. ; Gambacorta, M. A. ; Verbo, A. ; Barbaro, B. ; Vecchio, F. M. ; Pafundi, D. P. ; Mastromarino, M. G. ; Valentini, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-eb11821ba875d7e9d1005f4fbdc4f4a1ed36ccae69fdb8af8e772bbcc5c784713</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer therapies</topic><topic>Chemoradiotherapy - methods</topic><topic>Colorectal cancer</topic><topic>Defecation - physiology</topic><topic>Endoscopy</topic><topic>Fecal incontinence</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Italy - epidemiology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Microsurgery</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Morbidity - trends</topic><topic>Mortality</topic><topic>Natural Orifice Endoscopic Surgery - methods</topic><topic>Neoadjuvant Therapy</topic><topic>Postoperative period</topic><topic>Proctology</topic><topic>Radiation therapy</topic><topic>Rectal Neoplasms - epidemiology</topic><topic>Rectal Neoplasms - physiopathology</topic><topic>Rectal Neoplasms - therapy</topic><topic>Rectum</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surveys and Questionnaires</topic><topic>Time Factors</topic><topic>Tomography</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Coco, C.</creatorcontrib><creatorcontrib>Rizzo, G.</creatorcontrib><creatorcontrib>Mattana, C.</creatorcontrib><creatorcontrib>Gambacorta, M. A.</creatorcontrib><creatorcontrib>Verbo, A.</creatorcontrib><creatorcontrib>Barbaro, B.</creatorcontrib><creatorcontrib>Vecchio, F. M.</creatorcontrib><creatorcontrib>Pafundi, D. P.</creatorcontrib><creatorcontrib>Mastromarino, M. G.</creatorcontrib><creatorcontrib>Valentini, V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Coco, C.</au><au>Rizzo, G.</au><au>Mattana, C.</au><au>Gambacorta, M. A.</au><au>Verbo, A.</au><au>Barbaro, B.</au><au>Vecchio, F. M.</au><au>Pafundi, D. P.</au><au>Mastromarino, M. G.</au><au>Valentini, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-08-01</date><risdate>2013</risdate><volume>27</volume><issue>8</issue><spage>2860</spage><epage>2867</epage><pages>2860-2867</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Transanal endoscopic microsurgery (TEM) after radiochemotherapy (RCT) has been reported in selected cases of locally advanced rectal cancer as an alternative to traditional radical resection with total mesorectal excision with a curative intent or as diagnostic tool to confirm a pathological complete response of the primary tumor. No study has evaluated functional outcome after TEM in preoperatively irradiated patients.
Methods
This study was designed to evaluate short-term morbidity (according to Clavien’s classifications) and establish (by a questionnaire) continence and evacuative function after RCT and TEM, at 1 year from surgery, analyzing the impact of RCT on postoperative outcomes. Patients with locally advanced rectal cancer treated by RCT and TEM (group 1) or with early T1 or adenomas treated only by TEM (group 2) entered this cohort comparative study.
Results
Twenty-two patients entered the study as group 1 and 25 as group 2. No postoperative mortality occurred. The morbidity rate was 36.4 % in group 1 vs. 16 % in group 2 (
p
= 0.114). The rate of suture dehiscence was 22.7 % in group 1 vs. 4 % in group 2 (
p
= 0.068). No grade III complications, reoperation, or hospital readmission within 30 days was recorded in either group. One year after surgery, continence and evacuative scores in group 1 were 1.05 ± 1.25 and 24.72 ± 2.79, respectively, which were similar to group 2 (
p
= 0.081 and 0.288, respectively).
Conclusions
TEM after RCT in selected rectal cancer patients has an acceptable morbidity and functional results at 1 year from surgery. Preoperative irradiation could increase postoperative short-term morbidity, but it does not seem to influence evacuative or sphincter function after 1 year from surgery.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23404153</pmid><doi>10.1007/s00464-013-2842-6</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Cancer therapies Chemoradiotherapy - methods Colorectal cancer Defecation - physiology Endoscopy Fecal incontinence Female Follow-Up Studies Gastroenterology Gynecology Hepatology Humans Italy - epidemiology Male Medicine Medicine & Public Health Microsurgery Microsurgery - methods Middle Aged Morbidity Morbidity - trends Mortality Natural Orifice Endoscopic Surgery - methods Neoadjuvant Therapy Postoperative period Proctology Radiation therapy Rectal Neoplasms - epidemiology Rectal Neoplasms - physiopathology Rectal Neoplasms - therapy Rectum Retrospective Studies Surgery Surveys and Questionnaires Time Factors Tomography Treatment Outcome Ultrasonic imaging |
| title | Transanal endoscopic microsurgery after neoadjuvant radiochemotherapy for locally advanced extraperitoneal rectal cancer: short-term morbidity and functional outcome |
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