Yap Kiryu, Mills Sarah, Thomas Michelle, Moore James
Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2017 Nov;87(11):903-907. doi: 10.1111/ans.13791. Epub 2016 Oct 9.
To establish the incidence of unsuspected malignancy in lesions excised through transanal endoscopic microsurgery (TEM) and examine the justification for full-thickness excision of all lesions thought to be benign pre-operatively.
Demographic, operative and pathology data of all patients undergoing TEM at a single institution were collected in a prospectively maintained database. Follow-up data were collected with a focus on polyp recurrence rates and outcome in patients found to harbour malignancy. For lesions thought to be benign pre-operatively, a submucosal excision was routinely performed.
TEM was attempted in 156 cases between June 1999 and April 2013. Mean (standard deviation) patient age was 66.8 (2.1) years, with 111 males. Mean tumour size was 4.1 (1.6) cm, and mean height from anal verge was 10.4 (2.1) cm. In nine cases, the procedure was unable to be completed and in eight cases a deliberate full-thickness excision was performed. In 139 patients with a presumed benign lesion, mean operating time was 53.4 min. A total of 17 (12.2%) were found to harbour an unsuspected malignancy. Recurrent polyp was seen in 14 (11.7%) of 122 cases of benign pathology (mean follow-up 24.5 months) and was managed by endoscopic means in 10 patients. Mean length of stay was 1.2 days and complications occurred in 7% of cases. No patient with an unsuspected malignancy has developed recurrent disease (mean follow-up 43 months).
Submucosal TEM can result in low complication rates, short duration of surgery, short hospital stay and satisfactory recurrence rates when performed for presumed benign rectal tumours.
确定经肛门内镜显微手术（TEM）切除病变中未被怀疑的恶性肿瘤的发生率，并探讨对所有术前被认为是良性的病变进行全层切除的合理性。
将在单一机构接受TEM治疗的所有患者的人口统计学、手术和病理数据收集到一个前瞻性维护的数据库中。收集随访数据，重点关注息肉复发率和发现患有恶性肿瘤患者的结局。对于术前被认为是良性的病变，常规进行黏膜下切除。
1999年6月至2013年4月期间共尝试进行了156例TEM手术。患者平均（标准差）年龄为66.8（2.1）岁，其中男性111例。肿瘤平均大小为4.1（1.6）cm，距肛缘平均高度为10.4（2.1）cm。9例手术未能完成，8例进行了有意的全层切除。139例被认为是良性病变的患者，平均手术时间为53.4分钟。共发现17例（12.2%）存在未被怀疑的恶性肿瘤。122例良性病理患者中有14例（11.7%）出现息肉复发（平均随访24.5个月），其中10例通过内镜手段进行了处理。平均住院时间为1.2天，7%的病例发生了并发症。未发现有未被怀疑的恶性肿瘤的患者出现复发病例（平均随访43个月）。
对于假定为良性的直肠肿瘤，黏膜下TEM手术可导致低并发症发生率、短手术时间、短住院时间和令人满意的复发率。
