J Ramkumar1, A Karimuddin2, P Phang2, M Raval2, C Brown2. 1Division of General Surgery, Vancouver General Hospital, Vancouver, BC, Canada, 2Department of Surgery, Section of Colorectal Surgery, St. Paul’s Hospital, Vancouver, BC, Canada
Introduction: Transanal endoscopic microsurgery (TEM) is the treatment of choice for certain types of early stage rectal cancers and rectal polyps. This surgical approach has become ubiquitous and surgeons are seeing recurrent lesions after TEM resection. This study aims to outline the safety and outcomes of repeat TEM.
Methods: At St. Paul’s Hospital, demographic, surgical, pathologic, and follow up data for all patients treated by TEM is maintained in a prospectively populated database. Two groups were established for comparison: patients undergoing first TEM procedure (TEM-P) and patients undergoing repeat TEM procedure (TEM-R). Statistical analysis was performed using student’s t or chi-squared test, where appropriate.
Results: Between 2007 and 2017, 669 patients had their first TEM procedure (TEM-P). 57 patients underwent repeat TEM (TEM-R) including 13 of these surgeries being multiple repeat TEM. Indications for repeat TEM included recurrence (78%), positive margins (15%), and metachronous lesions (7%). There were no differences between the groups in patient age, gender, or tumour histology. Compared to TEM-P, TEM-R had shorter operative times (38 vs 52 mins, p < 0.001), more proximal lesions (7 vs 5cm, p < 0.004), and larger lesions (4 vs 3 cm, p < 0.0003). The TEM-R group had similar length of hospital stay (0.45 vs 0.56 days, p=0.65), rates of clear margins on pathology (80% vs 88%, p=0.09), 30-day readmission rates (6% vs 4%, p=0.28), and post-operative bleeding rate (5% vs 2%, p= 0.90) when compared to TEM-P group. Repeat TEM was associated with no post-operative urinary retention and similar post-operative complications as first TEM graded on the Clavien-Dindo classification scale (Grade 1: 8% vs 5%, Grade 2: 5% vs. 4%, Grade 3: 5% vs 1%, p=0.53) No 30-day mortality occurred in either group.
Conclusion: The St. Paul’s Hospital TEM experience suggests repeat TEM is a safe and feasible procedure with similar outcomes as patients undergoing first TEM.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86846
Program Number: S123
Presentation Session: Colorectal 2 Session
Presentation Type: Podium
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