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Transanal Endoscopic Operation Versus Conventional Transanal Excision for Rectal Tumors: Case-Matched Study with Propensity Score Matching.

 Jeonghee Han  ;  Gyoung Tae Noh  ;  Chinock Cheong  ;  Min Soo Cho  ;  Hyuk Hur  ;  Byung Soh Min  ;  Kang Young Lee  ;  Nam Kyu Kim 
 World Journal of Surgery, Vol.41(9) : 2387-2394, 2017 
Journal Title
 World Journal of Surgery 
Issue Date
Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Neoplasm, Residual ; Propensity Score ; Rectal Neoplasms/surgery* ; Rectum/pathology* ; Retrospective Studies ; Transanal Endoscopic Surgery/adverse effects ; Transanal Endoscopic Surgery/methods*
BACKGROUNDS: Although transanal endoscopic surgery is practiced worldwide, there is no consensus on comparative outcomes between transanal endoscopic operation (TEO) and transanal excision (TAE). In this study, we reviewed our experiences with these techniques and compared patients who underwent TEO and TAE using propensity score matching (PSM). METHODS: A total of 207 patients underwent local rectal tumor excision between January 2008 and November 2015. To overcome selection bias, we used PSM to achieve a one-to-one TEO: TAE ratio. We included baseline characteristics, age, sex, surgeon, American Society of Anesthesiologists score, tumor location (clockwise direction), involved circumference quadrants, tumor size, and pathology. RESULTS: After PSM, 72 patients were included in each group. The tumor distance from the anal verge was higher in the TEO group (8.0 [5-10] vs. TAE: 4.0 [3-5], p < 0.001). Complication rates did not differ between the groups (TEO: 8.3% vs. TAE: 11.1%, p = 0.39). TEO was associated with a shorter hospital stay (3.01 vs. 4.68 days, p = 0.001), higher negative margin rate (95.8 vs. 86.1%, p = 0.039), and non-fragmented specimen rate vs. TAE (98.6 vs. 90.3%, p = 0.029). CONCLUSIONS: TEO was more beneficial for patients with higher rectal tumors. Regardless of tumor location, involved circumference quadrants, and tumor size, TEO may more effectively achieve negative resection margins and non-fragmented specimens. Consequently, although local excision method according to tumor distance may be important, TEO will become the standard for rectal tumors.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실)
Yonsei Authors
김남규(Kim, Nam Kyu) ORCID logo https://orcid.org/0000-0003-0639-5632
민병소(Min, Byung Soh)
이강영(Lee, Kang Young)
정진옥(Cheong, Chin Ock)
조민수(Cho, Min Soo)
한정희(Han, Jeong Hee)
허혁(Hur, Hyuk) ORCID logo https://orcid.org/0000-0002-9864-7229
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