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Surgical Endoscopy
Erschienen in: Surgical Endoscopy 3/2018

15.08.2017

Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms

verfasst von: Lawrence Lee, Justin Kelly, George J. Nassif, Deborah Keller, Teresa C. Debeche-Adams, Paul A. Mancuso, John R. Monson, Matthew R. Albert, Sam B. Atallah

Erschienen in: Surgical Endoscopy | Ausgabe 3/2018

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Abstract

Introduction

Transanal minimally invasive surgery (TAMIS) is an endoscopic operating platform for local excision of rectal neoplasms. However, it may be technically demanding, and its learning curve has yet to be adequately defined. The objective of this study was to determine the number of TAMIS procedures for the local excision of rectal neoplasm required to reach proficiency.

Methods and procedures

All TAMIS cases performed from 07/2009 to 12/2016 at a single high-volume tertiary care institution for local excision of benign and malignant rectal neoplasia were identified from a prospective database. A cumulative summation (CUSUM) analysis was performed to determine the number of cases required to reach proficiency. The main proficiency outcome was rate of margin positivity (R1 resection). The acceptable and unacceptable R1 rates were defined as the R1 rate of transanal endoscopic microsurgery (TEM—10%) and traditional transanal excision (TAE—26%), which was obtained from previously published meta-analyses. Comparisons of patient, tumor, and operative characteristics before and after TAMIS proficiency were performed.

Results

A total of 254 TAMIS procedures were included in this study. The overall R1 resection rate was 7%. The indication for TAMIS was malignancy in 57%. CUSUM analysis reported that TAMIS reached an acceptable R1 rate between 14 and 24 cases. Moving average plots also showed that the mean operative times stabilized by proficiency gain. The mean lesion size was larger after proficiency gain (3.0 cm (SD 1.5) vs. 2.3 cm (SD 1.3), p = 0.008). All other patient, tumor, and operative characteristics were similar before and after proficiency gain.

Conclusions

TAMIS for local excision of rectal neoplasms is a complex procedure that requires a minimum of 14–24 cases to reach an acceptable R1 resection rate and lower operative duration.
Literatur
1.
Allaix ME, Fichera A (2013) Modern rectal cancer multidisciplinary treatment: the role of radiation and surgery. Ann Surg Oncol 20:2921–2928CrossRefPubMed
2.
Atallah S, Keller D (2015) Why the conventional parks transanal excision for early stage rectal cancer should be abandoned. Dis Colon Rectum 58:1211–1214CrossRefPubMed
3.
Bentrem DJ, Okabe S, Wong WD, Guillem JG, Weiser MR, Temple LK, Ben-Porat LS, Minsky BD, Cohen AM, Paty PB (2005) T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 242:472–477PubMedPubMedCentral
4.
Endreseth BH, Myrvold HE, Romundstad P, Hestvik UE, Bjerkeset T, Wibe A, Norwegian Rectal Cancer G (2005) Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 48:1380–1388CrossRefPubMed
5.
Chakravarti A, Compton CC, Shellito PC, Wood WC, Landry J, Machuta SR, Kaufman D, Ancukiewicz M, Willett CG (1999) Long-term follow-up of patients with rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230:49–54CrossRefPubMedPubMedCentral
6.
Stitzenberg KB, Sanoff HK, Penn DC, Meyers MO, Tepper JE (2013) Practice patterns and long-term survival for early-stage rectal cancer. J Clin Oncol 31:4276–4282CrossRefPubMedPubMedCentral
7.
Monson JR, Weiser MR, Buie WD, Chang GJ, Rafferty JF, Buie WD, Rafferty J, Standards Practice Task Force of the American Society of C, Rectal S (2013) Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum 56:535–550CrossRefPubMed
8.
Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1030 discussion 1030–1021 CrossRefPubMed
9.
Buess G, Theiss R, Gunther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35CrossRefPubMed
10.
Atallah S, Albert M, Larach S (2010) Transanal minimally invasive surgery: a giant leap forward. Surg Endosc 24:2200–2205CrossRefPubMed
11.
Clancy C, Burke JP, Albert MR, O’Connell PR, Winter DC (2015) Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum 58:254–261CrossRefPubMed
12.
Demartines N, von Flue MO, Harder FH (2001) Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 25:870–875CrossRefPubMed
13.
Barendse RM, Dijkgraaf MG, Rolf UR, Bijnen AB, Consten EC, Hoff C, Dekker E, Fockens P, Bemelman WA, de Graaf EJ (2013) Colorectal surgeons’ learning curve of transanal endoscopic microsurgery. Surg Endosc 27:3591–3602CrossRefPubMed
14.
Maya A, Vorenberg A, Oviedo M, da Silva G, Wexner SD, Sands D (2014) Learning curve for transanal endoscopic microsurgery: a single-center experience. Surg Endosc 28:1407–1412CrossRefPubMed
15.
Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW (2013) Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum 56:301–307CrossRefPubMed
16.
Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480CrossRefPubMed
17.
Keller DS, Tahilramani RN, Flores-Gonzalez JR, Mahmood A, Haas EM (2016) Transanal minimally invasive surgery: review of indications and outcomes from 75 consecutive patients. J Am Coll Surg 222:814–822CrossRefPubMed
18.
Lee L, Burke JP, deBeche-Adams T, Nassif G, Martin-Perez B, Monson JR, Albert MR, Atallah SB (2017) Transanal minimally invasive surgery for local excision of benign and malignant rectal neoplasia: outcomes from 200 consecutive cases with midterm follow up. Ann Surg. doi:10.​1097/​SLA.​0000000000002190​ PubMedCentral
19.
Bolsin S, Colson M (2000) The use of the Cusum technique in the assessment of trainee competence in new procedures. Int J Qual Health Care 12:433–438CrossRefPubMed
20.
Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860CrossRefPubMed
21.
Pendlimari R, Holubar SD, Dozois EJ, Larson DW, Pemberton JH, Cima RR (2012) Technical proficiency in hand-assisted laparoscopic colon and rectal surgery: determining how many cases are required to achieve mastery. Arch Surg 147:317–322CrossRefPubMed
22.
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91CrossRefPubMedPubMedCentral
23.
Tekkis PP, Fazio VW, Lavery IC, Remzi FH, Senagore AJ, Wu JS, Strong SA, Poloneicki JD, Hull TL, Church JM (2005) Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg 241:262–268CrossRefPubMedPubMedCentral
24.
Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Fuzesi L, Becker H (2003) Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 18:222–229PubMed
25.
de Graaf EJ, Burger JW, van Ijsseldijk AL, Tetteroo GW, Dawson I, Hop WC (2011) Transanal endoscopic microsurgery is superior to transanal excision of rectal adenomas. Colorectal Dis 13:762–767CrossRefPubMed
26.
Lebedyev A, Tulchinsky H, Rabau M, Klausner JM, Krausz M, Duek SD (2009) Long-term results of local excision for T1 rectal carcinoma: the experience of two colorectal units. Tech Coloproctol 13:231–236CrossRefPubMed
27.
Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO (2009) Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249:776–782CrossRefPubMed
28.
Martin-Perez B, Andrade-Ribeiro GD, Hunter L, Atallah S (2014) A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013. Tech Coloproctol 18:775–788CrossRefPubMed
29.
Hahnloser D, Cantero R, Salgado G, Dindo D, Rega D, Delrio P (2015) Transanal minimal invasive surgery for rectal lesions: should the defect be closed? Colorectal Dis 17:397–402CrossRefPubMed
30.
Morino M, Allaix ME, Famiglietti F, Caldart M, Arezzo A (2013) Does peritoneal perforation affect short- and long-term outcomes after transanal endoscopic microsurgery? Surg Endosc 27:181–188CrossRefPubMed
31.
Ramwell A, Evans J, Bignell M, Mathias J, Simson J (2009) The creation of a peritoneal defect in transanal endoscopic microsurgery does not increase complications. Colorectal Dis 11:964–966CrossRefPubMed
32.
Baatrup G, Borschitz T, Cunningham C, Qvist N (2009) Perforation into the peritoneal cavity during transanal endoscopic microsurgery for rectal cancer is not associated with major complications or oncological compromise. Surg Endosc 23:2680–2683CrossRefPubMed
33.
Hompes R, Rauh SM, Ris F, Tuynman JB, Mortensen NJ (2014) Robotic transanal minimally invasive surgery for local excision of rectal neoplasms. Br J Surg 101:578–581CrossRefPubMed
34.
Huscher CG, Bretagnol F, Ponzano C (2015) Robotic-assisted transanal total mesorectal excision: the key against the Achilles’ heel of rectal cancer? Ann Surg 261:e120–e121CrossRefPubMed
35.
Helewa RM, Rajaee AN, Raiche I, Williams L, Paquin-Gobeil M, Boushey RP, Moloo H (2016) The implementation of a transanal endoscopic microsurgery programme: initial experience with surgical performance. Colorectal Dis 18:1057–1062CrossRefPubMed
36.
Darzi A, Smith S, Taffinder N (1999) Assessing operative skill. Needs to become more objective. BMJ 318:887–888PubMed
37.
Chen W, Sailhamer E, Berger DL, Rattner DW (2007) Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery. Surg Endosc 21:238–243CrossRefPubMed
38.
Sng KK, Hara M, Shin JW, Yoo BE, Yang KS, Kim SH (2013) The multiphasic learning curve for robot-assisted rectal surgery. Surg Endosc 27:3297–3307CrossRefPubMed
39.
Jimenez-Rodriguez RM, Diaz-Pavon JM, de la Portilla de Juan F, Prendes-Sillero E, Dussort HC, Padillo J (2013) Learning curve for robotic-assisted laparoscopic rectal cancer surgery. Int J Colorectal Dis 28:815-821
40.
Barrie J, Jayne DG, Wright J, Murray CJ, Collinson FJ, Pavitt SH (2014) Attaining surgical competency and its implications in surgical clinical trial design: a systematic review of the learning curve in laparoscopic and robot-assisted laparoscopic colorectal cancer surgery. Ann Surg Oncol 21:829–840CrossRefPubMed
41.
Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2001) Statistical assessment of the learning curves of health technologies. Health Technol Assess 5:1–79CrossRefPubMed
42.
43.
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC (2015) Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum 58:122–140CrossRefPubMed
44.
Atallah SB, Albert MR (2013) Transanal minimally invasive surgery (TAMIS) versus transanal endoscopic microsurgery (TEM): is one better than the other? Surg Endosc 27:4750–4751CrossRefPubMed
45.
Melin AA, Kalaskar S, Taylor L, Thompson JS, Ternent C, Langenfeld SJ (2016) Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior? Am J Surg 212:1063–1067CrossRefPubMed
46.
Arezzo A, Passera R, Saito Y, Sakamoto T, Kobayashi N, Sakamoto N, Yoshida N, Naito Y, Fujishiro M, Niimi K, Ohya T, Ohata K, Okamura S, Iizuka S, Takeuchi Y, Uedo N, Fusaroli P, Bonino MA, Verra M, Morino M (2014) Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28:427–438CrossRefPubMed
47.
Campbell ML, Vadas KJ, Rasheid SH, Marcet JE, Sanchez JE (2014) A reproducible ex vivo model for transanal minimally invasive surgery. JSLS 18:62–65CrossRefPubMedPubMedCentral
48.
Bach SP, Hill J, Monson JR, Simson JN, Lane L, Merrie A, Warren B, Mortensen NJ, Association of Coloproctology of Great B, Ireland Transanal Endoscopic Microsurgery C (2009) A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer. Br J Surg 96:280–290CrossRefPubMed
Metadaten
Titel
Establishing the learning curve of transanal minimally invasive surgery for local excision of rectal neoplasms
verfasst von
Lawrence Lee
Justin Kelly
George J. Nassif
Deborah Keller
Teresa C. Debeche-Adams
Paul A. Mancuso
John R. Monson
Matthew R. Albert
Sam B. Atallah
Publikationsdatum
15.08.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 3/2018
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5817-1

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