cf57bbc59f4f7c6040df6c7e1fffe5b2 256533.pdf 007386fcdcc80184594a5d0683f82cb6e05a9a99 256533.pdf c4d1c0fdffc81301a4c35239007714a393d50ed4efe14799b528bd389a6f6c15 256533.pdf Title: Preoperative Diagnostic Uncertainty in T2–T3 Rectal Adenomas and T1–T2 Adenocarcinomas and a Therapeutic Dilemma: Transanal Endoscopic Surgery, or Total Mesorectal Excision? Subject: Background: Endorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, or between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: transanal endoscopic surgery (TES) or total mesorectal excision (TME)? Methods: An observational study of a cohort of 803 patients who underwent TES from 2004 to 2021. Patients operated on for adenoma (group I) and low-grade T1 adenocarcinoma (group II) were included. The variables related to uncertain diagnosis, and to the definitive pathological diagnosis of adenocarcinoma stage higher than T1, were analyzed. Results: A total of 638 patients were included. Group I comprised 529 patients, 113 (21.4%) with uncertain diagnosis. Seventeen (15%) eventually had a pathological diagnosis of adenocarcinoma higher than T1. However, the variable diagnostic uncertainty was a risk factor for adenocarcinoma above T1 (OR 2.3, 95% CI 1.1–4.7). Group II included 109 patients, eight with uncertain diagnosis (7.3%). Two patients presented a definitive pathological diagnosis of adenocarcinoma above T1. Conclusions: On the strength of these data, we recommend TES as the initial indication in cases of diagnostic uncertainty. Multicenter studies with larger samples for both groups should now be performed to further assess this strategy of initiating treatment with TES. Keywords: rectal adenoma; early rectal adenocarcinoma; transanal endoscopic surgery; total mesorectal excision Author: Xavier Serra-Aracil, Noemi Montes, Laura Mora-Lopez, Anna Serracant, Carles Pericay, Pere Rebasa and Salvador Navarro-Soto Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Jul 22 15:52:09 2021 CEST ModDate: Fri Jul 23 07:48:13 2021 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 666825 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YOSCZR+VnURWPalladioL Type 1 Custom yes yes no 10 0 AUANAP+URWPalladioL-Ital Type 1 Custom yes yes no 15 0 JSPFDH+URWPalladioL-Bold Type 1 Custom yes yes no 20 0 QJYSRV+URWPalladioL-Roma Type 1 Custom yes yes no 24 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 33 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 55 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 59 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 63 0 CNXSVA+CMSY10 Type 1 Builtin yes yes no 75 0 LOPHII+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 92 0 LOPHJJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 95 0 LOPHJK+PalatinoLinotype TrueType WinAnsi yes yes no 101 0 LOPHJM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 104 0 LOPIIH+TimesNewRoman CID TrueType Identity-H yes yes yes 107 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 120 0 OCUJDN+PazoMath Type 1 Builtin yes yes no 130 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-10-21 02:42:35 CEST RepresentationInformation: 256533.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-07-13 13:46:34 CEST Size: 666825 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 278 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Materials and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Children: Item: Title: Study Design Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Patients and Setting Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: Inclusion Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Exclusion Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Definition of Group I and II Patients with Tumors of Uncertain Diagnosis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Preoperative Preparation, Surgical Technique and Postoperative Evolution Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Main Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Secondary and Other Study Variables Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Children: Item: Title: Descriptive Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@76a3e297 Item: Title: ERUS and MR of the Patients with Uncertain Diagnosis in Relation to the Definitive Pathology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4d3167f4 Item: Title: Univariate Analysis of Patient and Tumor Variables with Respect to the Variable “Uncertain Diagnosis” Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@ed9d034 Item: Title: Univariate and Multivariate Analysis of Patient and Tumor Variables with Respect to the Pathological Diagnostic Variable “pT Greater Than T1” Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@6121c9d6 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@87f383f Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@4eb7f003 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@eafc191 Info: Title: Preoperative Diagnostic Uncertainty in T2 T3 Rectal Adenomas and T1 T2 Adenocarcinomas and a Therapeutic Dilemma: Transanal Endoscopic Surgery, or Total Mesorectal Excision? Author: Xavier Serra-Aracil, Noemi Montes, Laura Mora-Lopez, Anna Serracant, Carles Pericay, Pere Rebasa and Salvador Navarro-Soto Subject: Background: Endorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, or between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: transanal endoscopic surgery (TES) or total mesorectal excision (TME)? Methods: An observational study of a cohort of 803 patients who underwent TES from 2004 to 2021. Patients operated on for adenoma (group I) and low-grade T1 adenocarcinoma (group II) were included. The variables related to uncertain diagnosis, and to the definitive pathological diagnosis of adenocarcinoma stage higher than T1, were analyzed. Results: A total of 638 patients were included. Group I comprised 529 patients, 113 (21.4%) with uncertain diagnosis. Seventeen (15%) eventually had a pathological diagnosis of adenocarcinoma higher than T1. However, the variable diagnostic uncertainty was a risk factor for adenocarcinoma above T1 (OR 2.3, 95% CI 1.1 4.7). Group II included 109 patients, eight with uncertain diagnosis (7.3%). Two patients presented a definitive pathological diagnosis of adenocarcinoma above T1. Conclusions: On the strength of these data, we recommend TES as the initial indication in cases of diagnostic uncertainty. Multicenter studies with larger samples for both groups should now be performed to further assess this strategy of initiating treatment with TES. 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