{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T05:26:36Z","timestamp":1730870796649,"version":"3.28.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Gastroenterol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n            Einleitung Trotz der Erfindung vor \u00fcber 40 Jahren hat sich die TEM nicht fl\u00e4chendeckend durchgesetzt. Gr\u00fcnde sind vor allem hohe Anschaffungskosten, die anspruchsvolle Technik und alternative Therapiem\u00f6glichkeiten (radikale Resektionsverfahren), die eine gr\u00f6\u00dfere onkologische Sicherheit bieten. Allerdings kann die Vermeidung gro\u00dfer Bauchoperation mit Stomaanlage und h\u00e4ufigeren Komplikationen das h\u00f6here Rezidivrisiko f\u00fcr einige Patienten aufwiegen.<\/jats:p><jats:p>Wir untersuchten die Resultate der modifizierten und in der Anschaffung kosteng\u00fcnstigeren V-TEM bei der Resektion von Adenomen und Karzinomen und diskutieren den heutigen Stellenwert des Verfahrens anhand der Literatur.<\/jats:p><jats:p>\n            Methode Zwischen 2003 und 2019 wurden 154 Patienten an 170 Befunden mittels V-TEM operiert. Die Daten zu Operation und Follow-up wurden retrospektiv erhoben und ausgewertet.<\/jats:p><jats:p>\n            Ergebnisse Das mediane Alter betrug 67 Jahre, 89 Patienten waren m\u00e4nnlich und 65 weiblich.  Die V-TEM wurde bei 79 Karzinomen, 77 Adenomen und 14 sonstigen Befunden eingesetzt. Die Komplikationsrate betrug 21,1%, eine R0-Resektion gelang in 78,8% der F\u00e4lle. Die Adenomrezidivrate betrug 7,3%, die Gesamtrezidivrate bei Karzinomen 11,9%, Lokalrezidive traten bei 6,8% auf. Das krankheitsspezifische \u00dcberleben betrug 100% nach 5 und 94,2% nach 10 Jahren.<\/jats:p><jats:p>\n            Diskussion Der erfolgreiche Einsatz der TEM bei Adenomen und Fr\u00fchkarzinomen ist unumstritten. Bei Karzinomen ab einem T1 high risk-Stadium muss jedoch mit Rezidivraten von \u00fcber 10% gerechnet werden, wohingegen mit radikalen Verfahren bessere Ergebnisse erzielt werden k\u00f6nnen, weshalb diese als Therapie der Wahl in diesen F\u00e4llen gelten. Es gibt jedoch kaum Unterschiede bez\u00fcglich der \u00dcberlebensraten, zudem bietet die TEM eine bessere postoperative Lebensqualit\u00e4t.  Insbesondere auch die Kombination neoadjuvanter Verfahren mit der TEM konnten in der Vergangenheit vielversprechende Ergebnisse bei fortgeschritteneren Stadien liefern. Weitere Studien und die geringeren Anschaffungskosten durch Modifikation zur V-TEM k\u00f6nnten der Methode in Zukunft gr\u00f6\u00dfere Popularit\u00e4t verleihen.<\/jats:p>","DOI":"10.1055\/a-2183-2175","type":"journal-article","created":{"date-parts":[[2024,1,10]],"date-time":"2024-01-10T23:51:57Z","timestamp":1704930717000},"page":"1025-1031","source":"Crossref","is-referenced-by-count":0,"title":["Die Transanale Endoskopische Mikrochirurgie (TEM) ist eine chirurgische Option zur Erhaltung der Stuhlkontinenz bei ausgew\u00e4hlten tiefsitzenden Rektumkarzinomen"],"prefix":"10.1055","volume":"62","author":[{"given":"Katrin Marlene","family":"Schaffitzel","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Thorax- und Gef\u00e4\u00dfchirurgie, Ostalb-Klinikum Aalen, Aalen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"zu Putlitz","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Thorax- und Gef\u00e4\u00dfchirurgie, Ostalb-Klinikum Aalen, Aalen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan Karl","family":"G\u00f6lder","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gastroenterologie, H\u00e4matoonkologie und Pneumologie, Ostalbkreis, Aalen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Kurek","sequence":"additional","affiliation":[{"name":"Radioonkologie Netzwerk Ostw\u00fcrttemberg, Aalen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Siech","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Thorax- und Gef\u00e4\u00dfchirurgie, Ostalb-Klinikum Aalen, Aalen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,1,10]]},"reference":[{"key":"ref1","first-page":"677","article-title":"Das System f\u00fcr die transanale endoskopische Rectumoperation","volume":"55","author":"G Buess","year":"1984","journal-title":"Der Chirurg; Zeitschrift f\u00fcr alle Gebiete der operativen Medizin"},{"key":"ref3","first-page":"e49","article-title":"Videoassistierte transanale endoskopische Mikrochirurgie von Rektumtumoren \u2013 V-TEM","volume":"139","author":"S Huschitt","year":"2014","journal-title":"Zentralblatt f\u00fcr Chirurgie"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1245\/ASO.2006.04.010","article-title":"Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers","volume":"13","author":"S Ganai","year":"2006","journal-title":"Annals of surgical oncology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1111\/j.1463-1318.2004.00724.x","article-title":"Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery","volume":"7","author":"BH Endreseth","year":"2005","journal-title":"Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2594","DOI":"10.1007\/s00464-012-2238-z","article-title":"Recurrence after transanal endoscopic microsurgery for large rectal adenomas","volume":"26","author":"ME Allaix","year":"2012","journal-title":"Surgical endoscopy"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1007\/s00464-009-0585-1","article-title":"Treatment of rectal adenomas by transanal endoscopic microsurgery: 15 years\u2019 experience","volume":"24","author":"M Guerrieri","year":"2010","journal-title":"Surgical endoscopy"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/DCR.0b013e3181bbd6ee","article-title":"Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendations","volume":"53","author":"BM Tsai","year":"2010","journal-title":"Diseases of the colon and rectum"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1111\/j.1463-1318.2006.01098.x","article-title":"Transanal endoscopic microsurgery: risk factors for local recurrence of benign rectal adenomas","volume":"8","author":"PA Whitehouse","year":"2006","journal-title":"Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1007\/BF02054683","article-title":"Surgical cure for early rectal carcinomas (T1). 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