{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:00:50Z","timestamp":1768453250676,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,6,22]],"date-time":"2015-06-22T00:00:00Z","timestamp":1434931200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2015,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the surgical outcome of transanal endoscopic surgery (TES) for rectal neoplasms in technically challenging indications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>All patients who underwent TES for a rectal neoplasm from 2007 to 2014 were included. Technically challenging indications included a tumour with (i) diameter \u2265\u00a05\u00a0cm, (ii) involving \u2265\u00a050% of the rectal circumference and (iii) located \u2265\u00a010\u00a0cm from the anal verge. Patients were divided into three groups according to how many of these features they had, as follows: Group 1, none; Group 2, one; Group 3, two or more.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 168 patients (80 benign and 88 malignant tumours) included in the study, 73 (44%) were in Group 1, 46 (27%) in Group 2 and 49 (29%) in Group 3. There was no difference between Group 1 and Group 2 with regard to peritoneal perforation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.210), severe postoperative morbidity (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.804), length of hospital stay (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.444), incomplete resection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.441), piecemeal resection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.740), locoregional recurrence (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.307) and long\u2010term symptomatic rectal stenosis (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.076). Conversely Group 3 showed significantly impaired results compared with Group 1 with regard to peritoneal perforation (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003), piecemeal resection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.005), incomplete resection (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.025), locoregional recurrence (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.035) and long\u2010term symptomatic rectal stenosis (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), but no difference in severe postoperative morbidity (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.328).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Transanal endoscopic surgery for rectal neoplasms appears to be safe and effective, even in patients presenting with a technically challenging tumours. Although the short\u2010 and long\u2010term outcomes after TES are worse in patients with highly challenging tumours, nevertheless the technique should still be considered in patients at high risk of requiring a proctectomy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.13000","type":"journal-article","created":{"date-parts":[[2015,5,15]],"date-time":"2015-05-15T15:18:10Z","timestamp":1431703090000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Is there a limit to transanal endoscopic surgery? A comparative study between standard and technically challenging indications among 168 consecutive patients"],"prefix":"10.1111","volume":"17","author":[{"given":"A.","family":"Saget","sequence":"first","affiliation":[{"name":"Department of Colorectal Surgery P\u00f4le des Maladies de l'Appareil Digestif Beaujon Hospital University Denis Diderot (Paris VII) Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Maggiori","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery P\u00f4le des Maladies de l'Appareil Digestif Beaujon Hospital University Denis Diderot (Paris VII) Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Petruciani","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery P\u00f4le des Maladies de l'Appareil Digestif Beaujon Hospital University Denis Diderot (Paris VII) Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Ferron","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery P\u00f4le des Maladies de l'Appareil Digestif Beaujon Hospital University Denis Diderot (Paris VII) Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y.","family":"Panis","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery P\u00f4le des Maladies de l'Appareil Digestif Beaujon Hospital University Denis Diderot (Paris VII) Clichy France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,6,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0937-9"},{"key":"e_1_2_8_3_1","unstructured":"National Comprehensive Cancer Network(2012)NCCN Clinical Pratice Guideline in Oncology: Rectal Cancer."},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3180603024"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000979"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4530"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31823604ac"},{"key":"e_1_2_8_8_1","article-title":"[Recommendations for clinical practice. 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