A scoring system to predict complex transanal endoscopic surgery
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and Other Interventional Techniques
A scoring system to predict complex transanal endoscopic surgery X. Serra‑Aracil1 · P. Rebasa‑Cladera1 · L. Mora‑Lopez1 · A. Pallisera‑Lloveras1 · S. Serra‑Pla1 · S. Navarro‑Soto1 Received: 15 July 2019 / Accepted: 11 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Since the introduction of screening for colorectal cancer, the use of transanal endoscopic surgery (TEM) has become increasingly popular. However, the technical difficulty of this surgery varies widely. The few studies of learning curve in TEM have produced very disparate results. The aim of this study is to distinguish between straightforward and complex procedures, in order to refer more difficult cases to centers with greater experience. Method Observational study with prospective data collection and retrospective analysis was carried out between June 2004 and January 2019. All TEMs performed on rectal tumors were included. The complexity of the procedure was defined according to the weighted mean surgical time for each surgeon. A predictive model of complexity was established, with a score higher than 5 indicating a complex lesion. Results During the study period, 773 TEMs were performed, 708 of which met the study’s inclusion criteria. One hundred and three tumors were defined as complex. Predictors of complexity were as follows: male sex (OR: 1.78, 95% CI 1.1–2.9, score: 1), tumor size > 5 cm (OR: 5.1, 95% CI 3.2–8.2, score: 4), TEM for recurrence (OR: 6.3, 95% CI 2.3–16.7, score: 5), and distance from the upper margin of the tumor to the anal verge > 15 cm (OR: 1.6, 95% CI 0.96–2.7, score: 1). Conclusions Rather than establishing the learning curve merely in terms of the number of TEM procedures performed, it is important to consider the surgical difficulty of the interventions. To this end, it is essential to differentiate simple TEMs from the complex ones. Keywords Learning curve · Transanal endoscopic surgery · TEM · TEO Transanal endoscopic surgery (transanal endoscopic micro‑ surgery, TEM [1]; transanal endoscopic operation, TEO [2]; transanal minimally invasive surgery, TAMIS [3]) has always been considered a complex technique. In contrast to laparoscopic surgery, surgeons have to work in a very small space with parallel movements. As for its learning curve, there are very few publications on the subject in the litera‑ ture: some authors have tried to define the minimum number of surgeries required, but the numbers proposed vary widely [4–7]. At one extreme, Barendse et al. [4] suggested 35 pro‑ cedures, and at the other study, Maya et al. [5] reported a reduction in the time taken to perform the surgical resection after just four interventions. * X. Serra‑Aracil [email protected] 1
Unidad de Coloproctología, Servicio de Cirugía General y del Ap. Digestivo, Parc Tauli Hospital Universitari. Institut d’investigació i innovació Parc Tauli I3PT, Universitat Autonoma de Barcelona, Parc Tauli s/n, 08208 Sabadell, Barcelona, Spain
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