COMBINED ENDOSCOPIC AND TRANSANAL SURGERY (TASER) FOR THE TREATMENT OF A LARGE RECTAL LESIONS: A CASE-SERIES

Aims:

Benign colon lesions may require bowel resection if endoscopic resection cannot be en-bloc performed to assess adequately for cancer.

Lesions can be not amenable for endoscopic removals either because they are too large or situated in difficult locations; in circumferential lesions can cause post-resectional strictures. Traditionally the recommendation for these lesions has been surgical resection, but morbidities associated with bowel resection are still significant.

The aim of this study was to evaluate the safety, technical and clinical efficacy of this procedure in these patients.

Methods:

All procedures were carried out under general anestesia with CO₂ insufflation. After surgical positioning of an anal GEL-PATH (GelPOINT path-transanal access platform), a standard gastroscope fitted with a cap and endoscopic knife (Hybrid knife, ERBE Medical) and surgical instrumentation were transanally used to perform the combined procedure: after submucosal injection, the proximal and distal margins of the lesions were endoscopically incided; endoscopic submucosal dissection were then performed under the surgical assistance, guidance and traction. An en-bloc circumferential dissection was achieved in all cases. The submucosal defect was finally surgically closed, to prevent stricture.

Results:

Six lesions in 6 patients (3/3, M/F, median age 62 years), referred to our Institution for treatment of circumferential large lateral spreading tumour (LST) of the rectum were treated by TASER: 5 granular mixed type LST and 1 non granular LST, with mean size of 5.8 cm (range 5 – 8 cm).

Histology of the resected specimens showed in 3 cases high grade dysplasia adenoma and in three cases adenocarcinoma (G2, pt1 in 2 cases and pt2 in 1 case). The latter patients underwent subsequent rectal resection. No complications were reported.

Conclusions:

For benign-appearing rectal lesions not amenable to endoscopic techniques alone, TASER may be an alternative to formal bowel resection for carefully selected patients. This initial experience shows that in experienced hands TASER procedure can be performed safely.