Kouladouros Konstantinos, Baral Jörg
Central Interdisciplinary Endoscopy Department, Department of Surgery, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Surgery Department, Karlsruhe Municipal Hospital, Moltkestrasse 90, 76133, Karlsruhe, Germany.
Langenbecks Arch Surg. 2022 Sep;407(6):2423-2430. doi: 10.1007/s00423-022-02562-0. Epub 2022 Jun 2.
Transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD) are currently the two most popular methods for resecting large rectal adenomas en bloc. However, damage to the mesorectum in the case of TEM, plus the technical challenges and long procedure times of flexible ESD, are major disadvantages of these procedures. Transanal endoscopic microsurgical submucosal dissection (TEM-ESD) is a new technique, combining the ergonomic features of TEM with the minimally invasive approach of ESD. The aim of our study was to assess the feasibility and safety of TEM-ESD for resection of large rectal adenomas.
We retrospectively analyzed all TEM-ESD procedures performed in Karlsruhe Municipal Hospital between 2012 and 2019, isolated all cases of adenomas, and analyzed the perioperative and follow-up data of the patients.
We identified 145 cases matching our criteria. The median size of the lesions was 4.2 cm, and the median operating time was 45 min. The en bloc resection rate was 100%, and the complete en bloc resection rate was 78.6%. The overall morbidity rate was 6.9%. In a median follow-up period of 24 months, there was a local recurrence in 4.8% of the cases.
TEM-ESD is a safe and feasible therapeutic option for resecting large rectal adenomas, offering high en bloc resection and low recurrence rates combined with short operating time and low morbidity. TRIAL REGISTRATION NUMBER (CLINICALTRIALS.GOV): NCT04870931.
经肛门内镜显微手术（TEM）和内镜黏膜下剥离术（ESD）是目前整块切除大型直肠腺瘤最常用的两种方法。然而，TEM会损伤直肠系膜，加上柔性ESD的技术挑战和手术时间长，是这些手术的主要缺点。经肛门内镜显微手术黏膜下剥离术（TEM-ESD）是一种新技术，它将TEM的人体工程学特点与ESD的微创方法相结合。我们研究的目的是评估TEM-ESD切除大型直肠腺瘤的可行性和安全性。
我们回顾性分析了2012年至2019年在卡尔斯鲁厄市立医院进行的所有TEM-ESD手术，分离出所有腺瘤病例，并分析了患者的围手术期和随访数据。
我们确定了145例符合我们标准的病例。病变的中位大小为4.2厘米，中位手术时间为45分钟。整块切除率为100%，完整整块切除率为78.6%。总体发病率为6.9%。在中位随访期24个月时，4.8%的病例出现局部复发。
TEM-ESD是切除大型直肠腺瘤的一种安全可行的治疗选择，具有高整块切除率和低复发率，同时手术时间短、发病率低。试验注册号（CLINICALTRIALS.GOV）：NCT04870931。
