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Transanal endoscopic microsurgery: safe for midrectal lesions in morbidly obese patients.

MedStar author(s):

Ayscue, Jennifer M

Chhitwal, Nandita

Citation: American Journal of Surgery. 204(3):402-5, 2012 Sep.PMID: 22578411Institution: MedStar Washington Hospital CenterDepartment: Surgery/Colorectal SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anal Canal | *Endoscopy, Gastrointestinal | *Microsurgery/mt [Methods] | *Obesity, Morbid/co [Complications] | *Rectal Neoplasms/pa [Pathology] | *Rectal Neoplasms/su [Surgery] | Aged | Ambulatory Surgical Procedures | Body Mass Index | Case-Control Studies | Female | Humans | Male | Middle Aged | Proctoscopes | Rectal Neoplasms/co [Complications] | Retrospective StudiesLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0002-9610

Name of journal: American journal of surgeryAbstract: BACKGROUND: Transanal endoscopic microsurgery is a safe option for proximal rectal tumors in morbidly obese patients for whom transabdominal pelvic dissection often is fraught with morbidity.CONCLUSIONS: Transanal endoscopic microsurgery in morbidly obese patients is a safe, feasible, and a viable alternative to low anterior resection. Copyright 2012 Elsevier Inc. All rights reserved.METHODS: From a database of 318 patients who underwent transanal endoscopic microsurgery, we report a retrospective case-control study of 9 patients with a body mass index range of 35 to 66 with sessile rectal lesions 6 to 15 cm from the anal verge who underwent transanal endoscopic microsurgery. Case subjects were compared with 15 controls and matched for age, tumor type, and level of tumor. The average body mass index of controls was 30 (P < .001). By using t test analysis, perioperative outcomes (surgical time, blood loss, and hospital length of stay) and postoperative complications were compared.RESULTS: Sessile tumors were located 7 to 11 cm from the anal verge with a diameter of 1 to 4 cm. Patient and tumor factors such as age, distal tumor margin from anal verge, and tumor diameter were not significantly different between case subjects and controls. Surgical blood loss, surgical time, and hospital length of stay were not significantly different between the 2 groups. One complication occurred among the cases. No complications occurred in the control group. All patients had complete surgical resections with negative margins.All authors: Ayscue JM, Chhitwal N, Coralic J, FitzGerald JF, Kumar AS, Smith LE, Stahl TJDigital Object Identifier:

http://dx.doi.org/10.1016/j.amjsurg.2011.11.011

Date added to catalog: 2013-09-17

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available		22578411

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Transanal endoscopic microsurgery is a safe option for proximal rectal tumors in morbidly obese patients for whom transabdominal pelvic dissection often is fraught with morbidity.

METHODS: From a database of 318 patients who underwent transanal endoscopic microsurgery, we report a retrospective case-control study of 9 patients with a body mass index range of 35 to 66 with sessile rectal lesions 6 to 15 cm from the anal verge who underwent transanal endoscopic microsurgery. Case subjects were compared with 15 controls and matched for age, tumor type, and level of tumor. The average body mass index of controls was 30 (P < .001). By using t test analysis, perioperative outcomes (surgical time, blood loss, and hospital length of stay) and postoperative complications were compared.

RESULTS: Sessile tumors were located 7 to 11 cm from the anal verge with a diameter of 1 to 4 cm. Patient and tumor factors such as age, distal tumor margin from anal verge, and tumor diameter were not significantly different between case subjects and controls. Surgical blood loss, surgical time, and hospital length of stay were not significantly different between the 2 groups. One complication occurred among the cases. No complications occurred in the control group. All patients had complete surgical resections with negative margins.

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