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Erschienen in: Surgical Endoscopy 6/2009

01.06.2009 | Endoluminal

Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings

verfasst von: Luigi Zorcolo, Giovanni Fantola, Francesco Cabras, Luigi Marongiu, Giuseppe D’Alia, Giuseppe Casula

Erschienen in: Surgical Endoscopy | Ausgabe 6/2009

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Abstract

Background

Accurate preoperative staging is the key to correct selection of rectal tumors for local excision. This study aims to assess the accuracy of endorectal ultrasound (ERUS) at our institution.

Patients and methods

Retrospective analysis was carried out of patients treated by transanal endoscopic microsurgery (TEM) from 1996 to 2008. TEM was considered the treatment of choice for uT0-1/N0 lesions located between 2 and 12 cm from the anal verge. It was also proposed in selected uT2-3 patients. Preoperative staging was compared with histopathologic findings.

Results

Eighty-one patients (46 males, mean age 66 years) underwent TEM. Mean distance of the tumor from the anal verge was 6.6 cm (range 2–12 cm). ERUS staged 15 of 27 adenomas (55%) as uT1. Of 54 carcinomas, 5 were pT0 because TEM was performed to remove resection margins of a malign polyp already snared. Five of 19 pTis (26%) were overstaged uT1, while 7 of 17 pT1 (41%) were understaged. Overall, ERUS enabled distinction between early and advanced rectal lesion with 96% sensitivity and 85% specificity, giving accuracy of 94% (65/67). Thirteen patients had advanced lesions (eight pT2 and five pT3). Only in two of them (15%) was depth of invasion underestimated by ERUS (one uT0, one uT1) and thus was subsequent salvage surgery necessary.

Conclusions

ERUS is useful to confirm the diagnosis of adenoma and predict depth of mural invasion in early rectal cancer. Differentiation between T0/is and T1 lesions remains challenging, however this does not usually influence surgical strategy.
Literatur
1.
Zurück zum Zitat Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284PubMedCrossRef Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284PubMedCrossRef
2.
Zurück zum Zitat Stipa F, Burza A, Lucandri G, Ferri M, Piazzi A, Ziparo V, Casula G, Stipa S (2006) Outcome of early rectal cancer patients managed with TEM. A 5 years’ follow up study. Surg Endosc 20:541–555PubMedCrossRef Stipa F, Burza A, Lucandri G, Ferri M, Piazzi A, Ziparo V, Casula G, Stipa S (2006) Outcome of early rectal cancer patients managed with TEM. A 5 years’ follow up study. Surg Endosc 20:541–555PubMedCrossRef
4.
Zurück zum Zitat Duek SD, Issa N, Hershko DD, Krausz MM (2008) Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum 51:379–384PubMedCrossRef Duek SD, Issa N, Hershko DD, Krausz MM (2008) Outcome of transanal endoscopic microsurgery and adjuvant radiotherapy in patients with T2 rectal cancer. Dis Colon Rectum 51:379–384PubMedCrossRef
5.
Zurück zum Zitat Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, García-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1074PubMedCrossRef Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, García-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1074PubMedCrossRef
6.
Zurück zum Zitat Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum—testing a new method in animal experiments. Leber Magen Darm 13:73–77PubMed Buess G, Theiss R, Hutterer F, Pichlmaier H, Pelz C, Holfeld T, Said S, Isselhard W (1983) Transanal endoscopic surgery of the rectum—testing a new method in animal experiments. Leber Magen Darm 13:73–77PubMed
7.
Zurück zum Zitat Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35PubMedCrossRef Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H (1985) Endoscopic surgery in the rectum. Endoscopy 17:31–35PubMedCrossRef
8.
Zurück zum Zitat Ikeda Y, Mori M, Abe T, Koyonagi N, Akahoshi K (1999) Indications for performing transanal endoscopic microsurgery in rectal cancer patients. Colorectal Dis 2:13–17CrossRef Ikeda Y, Mori M, Abe T, Koyonagi N, Akahoshi K (1999) Indications for performing transanal endoscopic microsurgery in rectal cancer patients. Colorectal Dis 2:13–17CrossRef
9.
Zurück zum Zitat Doornebosch PG, Bronkhorst PJB, Hop WCJ, Bode WA, Sing AK, de Graaf EJR (2008) The role of ERUS in therapeutic decision-making for local vs. transabdominal resection of rectal tumors. Dis Colon Rectum 51:38–42PubMedCrossRef Doornebosch PG, Bronkhorst PJB, Hop WCJ, Bode WA, Sing AK, de Graaf EJR (2008) The role of ERUS in therapeutic decision-making for local vs. transabdominal resection of rectal tumors. Dis Colon Rectum 51:38–42PubMedCrossRef
10.
Zurück zum Zitat Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Füzesi 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 Langer C, Liersch T, Suss M, Siemer A, Markus P, Ghadimi BM, Füzesi 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
11.
Zurück zum Zitat De Graaf EJ (2003) Transanal endoscopic microsurgery. Scand J Gastroenterology 239:34–39CrossRef De Graaf EJ (2003) Transanal endoscopic microsurgery. Scand J Gastroenterology 239:34–39CrossRef
12.
Zurück zum Zitat Lezoche E, Guerrieri M, Paganini AM, Baldarelli A, De Sanctis A, Lezoche G (2005) Long term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 12:1546–1552CrossRef Lezoche E, Guerrieri M, Paganini AM, Baldarelli A, De Sanctis A, Lezoche G (2005) Long term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 12:1546–1552CrossRef
13.
Zurück zum Zitat Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295PubMedCrossRef Kikuchi R, Takano M, Takagi K, Fujimoto N, Nozaki R, Fujiyoshi T, Uchida Y (1995) Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295PubMedCrossRef
14.
Zurück zum Zitat Maslekar S, Pillinger SH, Monson JRT (2007) Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 21:97–102PubMedCrossRef Maslekar S, Pillinger SH, Monson JRT (2007) Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 21:97–102PubMedCrossRef
15.
Zurück zum Zitat Stipa F, Ferri M, Lucandri G, Casula G, Ziparo V (2004) Local excision of rectal cancer with transanal endoscopic microsurgery (TEM). Anticancer Res 24:1167–1172PubMed Stipa F, Ferri M, Lucandri G, Casula G, Ziparo V (2004) Local excision of rectal cancer with transanal endoscopic microsurgery (TEM). Anticancer Res 24:1167–1172PubMed
16.
Zurück zum Zitat Hildebrandt U, Feifel G, Schwarz HP, Scherr O (1986) Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis 1 4:203–207CrossRef Hildebrandt U, Feifel G, Schwarz HP, Scherr O (1986) Endorectal ultrasound: instrumentation and clinical aspects. Int J Colorectal Dis 1 4:203–207CrossRef
17.
Zurück zum Zitat Sobin LH, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. Wiley Sobin LH, Wittekind C (2002) TNM classification of malignant tumours, 6th edn. Wiley
18.
Zurück zum Zitat Adams DR, Blatchford GJ, Lin KM, Ternent CA, Thorson AG (1999) Use of preoperative ERUS staging for treatment of rectal cancers. Dis Colon Rectum 42:159–166PubMedCrossRef Adams DR, Blatchford GJ, Lin KM, Ternent CA, Thorson AG (1999) Use of preoperative ERUS staging for treatment of rectal cancers. Dis Colon Rectum 42:159–166PubMedCrossRef
19.
Zurück zum Zitat Garcia-Aguilar J, Pollack J, Lee S, Hernandez de Anda E, Mellgren A, Wong W, Finne C, Rothenberger DA, Madoff RD (2002) Accuracy of ERUS in preoperative staging of rectal tumors. Dis Colon Rectum 45:10–15 Garcia-Aguilar J, Pollack J, Lee S, Hernandez de Anda E, Mellgren A, Wong W, Finne C, Rothenberger DA, Madoff RD (2002) Accuracy of ERUS in preoperative staging of rectal tumors. Dis Colon Rectum 45:10–15
20.
Zurück zum Zitat Hildebrandt U, Schuder G, Feifel G (1994) Preoperative staging of rectal and colonic cancer. Endoscopy 26:810–812PubMedCrossRef Hildebrandt U, Schuder G, Feifel G (1994) Preoperative staging of rectal and colonic cancer. Endoscopy 26:810–812PubMedCrossRef
21.
Zurück zum Zitat Glancy DG, Pullyblank AM, Thomas MG (2005) The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM). Colorectal Dis 7:148–150PubMedCrossRef Glancy DG, Pullyblank AM, Thomas MG (2005) The role of colonoscopic endoanal ultrasound scanning (EUS) in selecting patients suitable for resection by transanal endoscopic microsurgery (TEM). Colorectal Dis 7:148–150PubMedCrossRef
22.
Zurück zum Zitat Gualdi GF, Casciani E, Guadalaxara A, d’Orta C, Polettim E, Pappalardo G (2000) Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum 43:338–345PubMedCrossRef Gualdi GF, Casciani E, Guadalaxara A, d’Orta C, Polettim E, Pappalardo G (2000) Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings. Dis Colon Rectum 43:338–345PubMedCrossRef
23.
Zurück zum Zitat Zagoria RJ, Schlarb CA, Ott DJ, Bechtold RI, Wolfman NT, Scharling ES, Chen MY, Loggie BW (1997) Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparing with endoscopic rectal sonorography. J Surg Oncol 64:312–317PubMedCrossRef Zagoria RJ, Schlarb CA, Ott DJ, Bechtold RI, Wolfman NT, Scharling ES, Chen MY, Loggie BW (1997) Assessment of rectal tumor infiltration utilizing endorectal MR imaging and comparing with endoscopic rectal sonorography. J Surg Oncol 64:312–317PubMedCrossRef
24.
Zurück zum Zitat Maldjian C, Smith R, Kilger A, Schnall M, Ginsberg G, Kochman M (2000) Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonorography. Abdom Imaging 25:75–80PubMedCrossRef Maldjian C, Smith R, Kilger A, Schnall M, Ginsberg G, Kochman M (2000) Endorectal surface coil MR imaging as a staging technique for rectal carcinoma: a comparison study to rectal endosonorography. Abdom Imaging 25:75–80PubMedCrossRef
25.
Zurück zum Zitat Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, Bourne MW, Williams GT (1999) Rectal carcinoma. Thin-section MR imaging for staging in 28 patients. Radiology 211:215–222PubMed Brown G, Richards CJ, Newcombe RG, Dallimore NS, Radcliffe AG, Carey DP, Bourne MW, Williams GT (1999) Rectal carcinoma. Thin-section MR imaging for staging in 28 patients. Radiology 211:215–222PubMed
26.
Zurück zum Zitat Beets-Tan RG, Beets GL, Vliegen RF, Kessels AG, Van Boven H, De Bruine A, von Meyenfeldt MF, Baeten CG, van Engelshoven JM (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357:497–504PubMedCrossRef Beets-Tan RG, Beets GL, Vliegen RF, Kessels AG, Van Boven H, De Bruine A, von Meyenfeldt MF, Baeten CG, van Engelshoven JM (2001) Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357:497–504PubMedCrossRef
27.
Zurück zum Zitat Brown G, Radcliffe AG, Dallimore NS, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution MRI. Br J Surg 90:355–364PubMedCrossRef Brown G, Radcliffe AG, Dallimore NS, Williams GT (2003) Preoperative assessment of prognostic factors in rectal cancer using high-resolution MRI. Br J Surg 90:355–364PubMedCrossRef
28.
Zurück zum Zitat Kim NK, Kim MJ, Yun SH, Min JS (1999) Comparative study of transrectal ultrasonography, pelvic CT and MRI in preoperative staging of rectal cancer. Dis Colon Rectum 42:770–775PubMedCrossRef Kim NK, Kim MJ, Yun SH, Min JS (1999) Comparative study of transrectal ultrasonography, pelvic CT and MRI in preoperative staging of rectal cancer. Dis Colon Rectum 42:770–775PubMedCrossRef
29.
Zurück zum Zitat Ho-Kyung C, Dongil C, Min JK, Jongmee L, Seong HY, Seung HK, Soon JL, Chan KK (2006) Preoperative staging of rectal cancer: comparison of 3T high-field MRI and endorectal sonography. Gastrointest Imaging 187:1557–1562 Ho-Kyung C, Dongil C, Min JK, Jongmee L, Seong HY, Seung HK, Soon JL, Chan KK (2006) Preoperative staging of rectal cancer: comparison of 3T high-field MRI and endorectal sonography. Gastrointest Imaging 187:1557–1562
30.
Zurück zum Zitat Iafrate F, Laghi A, Paolantonio P, Rengo M, Mercantini P, Ferri M, Ziparo V, Passariello R (2006) Preoperative staging of rectal cancer with MR imaging: correlation with surgical and histopathologic findings. Radiographics 26:701–714PubMedCrossRef Iafrate F, Laghi A, Paolantonio P, Rengo M, Mercantini P, Ferri M, Ziparo V, Passariello R (2006) Preoperative staging of rectal cancer with MR imaging: correlation with surgical and histopathologic findings. Radiographics 26:701–714PubMedCrossRef
31.
Zurück zum Zitat Herzog U, von Flue M, Tondelli P, Schuppisser JP (1993) How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 36:127–134PubMedCrossRef Herzog U, von Flue M, Tondelli P, Schuppisser JP (1993) How accurate is endorectal ultrasound in the preoperative staging of rectal cancer? Dis Colon Rectum 36:127–134PubMedCrossRef
32.
Zurück zum Zitat Akasu T, Sugihara K, Moriya Y, Fujita S (1997) Limitations and pitfalls of transrectal ultrasonorography for staging of rectal cancer. Dis Colon Rectum 40:10–15CrossRef Akasu T, Sugihara K, Moriya Y, Fujita S (1997) Limitations and pitfalls of transrectal ultrasonorography for staging of rectal cancer. Dis Colon Rectum 40:10–15CrossRef
33.
Zurück zum Zitat Kwok H, Bisset IP, Hill GL (2000) Preoperative staging of rectal cancer. Int J Colorectal Dis 15:9–20PubMedCrossRef Kwok H, Bisset IP, Hill GL (2000) Preoperative staging of rectal cancer. Int J Colorectal Dis 15:9–20PubMedCrossRef
34.
Zurück zum Zitat Tio TL, Coene PP, van Delden OM, Tyagat GN (1991) Colorectal carcinoma: preoperative TNM classification with endosonorography. Radiology 179:165–170PubMed Tio TL, Coene PP, van Delden OM, Tyagat GN (1991) Colorectal carcinoma: preoperative TNM classification with endosonorography. Radiology 179:165–170PubMed
35.
Zurück zum Zitat Guinet C, Buy JN, Ghossain MA, Sézeur A, Mallet A, Bigot JM, Vadrot D, Ecoiffier J (1990) Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer. Arch Surg 125:385–388PubMed Guinet C, Buy JN, Ghossain MA, Sézeur A, Mallet A, Bigot JM, Vadrot D, Ecoiffier J (1990) Comparison of magnetic resonance imaging and computed tomography in the preoperative staging of rectal cancer. Arch Surg 125:385–388PubMed
36.
Zurück zum Zitat Holdsworth PJ, Johnston D, Chalmers AG, Chennells P, Dixon MF, Finan PJ, Primrose JN, Quirke P (1988) Endoluminal ultrasound and computed tomography in the staging of rectal cancer. Br J Surg 75:1019–1022PubMedCrossRef Holdsworth PJ, Johnston D, Chalmers AG, Chennells P, Dixon MF, Finan PJ, Primrose JN, Quirke P (1988) Endoluminal ultrasound and computed tomography in the staging of rectal cancer. Br J Surg 75:1019–1022PubMedCrossRef
37.
Zurück zum Zitat McNicholas MM, Joyce WP, Dolan J, Gibney RG, MacErlaine DP, Hyland J (1994) Magnetic resonance imaging of rectal carcinoma: a prospective study. Br J Surg 81:911–914PubMedCrossRef McNicholas MM, Joyce WP, Dolan J, Gibney RG, MacErlaine DP, Hyland J (1994) Magnetic resonance imaging of rectal carcinoma: a prospective study. Br J Surg 81:911–914PubMedCrossRef
38.
Zurück zum Zitat Hermanek P (1994) Lokale Therapie des Rektumkarzinoms. Springer, Berlin Hermanek P (1994) Lokale Therapie des Rektumkarzinoms. Springer, Berlin
39.
Zurück zum Zitat Haggitt R, Glotzbach RE, Softer EE, Wruble LD (1985) Prognostic factors in colorectal cancer in adenomas; implications for lesions removed by endoscopic polypectomy. Gastroenterology 89:328–336PubMed Haggitt R, Glotzbach RE, Softer EE, Wruble LD (1985) Prognostic factors in colorectal cancer in adenomas; implications for lesions removed by endoscopic polypectomy. Gastroenterology 89:328–336PubMed
40.
Zurück zum Zitat Tytherleigh MG, Warren BF, Mortensen NJ (2008) Management of early rectal cancer. Br J Surg 95:409–423PubMedCrossRef Tytherleigh MG, Warren BF, Mortensen NJ (2008) Management of early rectal cancer. Br J Surg 95:409–423PubMedCrossRef
42.
Zurück zum Zitat Chambers W, Khan U, Gagliano A, Smith RD, Sheffield J, Nicholls RJ (2004) Tumour morphology as a predictor of outcome after local excision of rectal cancer. Br J Sur 91:457–459CrossRef Chambers W, Khan U, Gagliano A, Smith RD, Sheffield J, Nicholls RJ (2004) Tumour morphology as a predictor of outcome after local excision of rectal cancer. Br J Sur 91:457–459CrossRef
Metadaten
Titel
Preoperative staging of patients with rectal tumors suitable for transanal endoscopic microsurgery (TEM): comparison of endorectal ultrasound and histopathologic findings
verfasst von
Luigi Zorcolo
Giovanni Fantola
Francesco Cabras
Luigi Marongiu
Giuseppe D’Alia
Giuseppe Casula
Publikationsdatum
01.06.2009
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 6/2009
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-009-0349-y

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