A multicenter retrospective study following all patients with rectal lesions resected with a transanal local excision approach was conducted from October 2010 to March 2020 (11 years) in six academic medical centers in Israel. A subsequent analysis of patients with a final pathology of low-grade dysplasia was conducted. The data collected included the operative platforms used (a standard transanal excision (TAE), a transanal minimally invasive surgery (TAMIS), and a transanal endoscopic microsurgery (TEM)); demographics characteristics (age, gender, body mass index (BMI); co-morbidities; American Society of Anesthesiology (ASA) score); preoperative studies performed, including endoscopy with rectal lesion biopsy (rigid proctoscopy, Flexible Sigmoidoscopy, Colonoscopy); abdominal and pelvic CT; and endorectal ultrasound (ERUS) or pelvic magnetic resonance imaging (MRI), or both.
Operative and postoperative data were collected, including operative approach, surgical findings, length of hospital stay, postoperative complications, morbidity, and mortality. The Clavien-Dindo classification of surgical complications score was used to classify postoperative complications [12 (link)]. Pathology reports were reviewed for histological characteristics such as size and resection margins. Out-patient visits and follow-up charts were reviewed for malignant recurrence and treatment after diagnosis of rectal malignancy. There was no standardized follow-up protocol, and various surveillance protocols were noted among the various centers. Polyps with any other pathology except low-grade dysplasia were excluded from the cohort.
Approval of the institutional review boards of all six participating centers was attained for the study (IRB 0179-20-MMC). All respective institutional review boards waived the need for individual informed consent by each patient for this retrospective study.
Statistical analyses were performed using EZR (Version 1.55) and R software (version 4.1.2) (Chugai Igakusha: Tokyo, Japan). Continuous data were expressed as mean and standard deviation when normally distributed or otherwise as the median and interquartile range (IQR). Student-t test or Mann–Whitney U test was used to analyze continuous variables. Categorical data were expressed as numbers and proportions and analyzed using Fisher exact or Chi-Square test. A p-value < 0.05 was considered significant.
Operative and postoperative data were collected, including operative approach, surgical findings, length of hospital stay, postoperative complications, morbidity, and mortality. The Clavien-Dindo classification of surgical complications score was used to classify postoperative complications [12 (link)]. Pathology reports were reviewed for histological characteristics such as size and resection margins. Out-patient visits and follow-up charts were reviewed for malignant recurrence and treatment after diagnosis of rectal malignancy. There was no standardized follow-up protocol, and various surveillance protocols were noted among the various centers. Polyps with any other pathology except low-grade dysplasia were excluded from the cohort.
Approval of the institutional review boards of all six participating centers was attained for the study (IRB 0179-20-MMC). All respective institutional review boards waived the need for individual informed consent by each patient for this retrospective study.
Statistical analyses were performed using EZR (Version 1.55) and R software (version 4.1.2) (Chugai Igakusha: Tokyo, Japan). Continuous data were expressed as mean and standard deviation when normally distributed or otherwise as the median and interquartile range (IQR). Student-t test or Mann–Whitney U test was used to analyze continuous variables. Categorical data were expressed as numbers and proportions and analyzed using Fisher exact or Chi-Square test. A p-value < 0.05 was considered significant.
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