Mucosectomy is an endoscopic procedure used for early-stage cancer that minimally invasively removes tumor-altered mucosa. Most commonly, mucosectomy is performed as part of a colonoscopy. The procedure is nearly a standard procedure in Germany and has a complication rate of only more than 1:1000 to 1:5000.
What is mucosectomy?
Mucosectomy is an endoscopic procedure used for early-stage cancer that minimally invasively removes tumor-altered mucosa. Most commonly, mucosectomy is performed as part of a colonoscopy. During a mucosectomy, the suspiciously altered mucosal tissue of a specific organ is removed endoscopically. The minimally invasive procedure is also known as endoscopic mucosal resection. To be distinguished from this is endoscopic submucosal dissection, which in the broadest sense corresponds to an extension of mucosectomy. The body’s own ability to regenerate is the basis of the procedure. Especially the mucous membranes of the organs are considered to be extremely regenerative. They usually cover a small wound with ingrowing cells starting from the wound edges in the course of natural regeneration processes. As long as the mucosectomy leaves deeper tissue layers intact, the wound area therefore heals relatively quickly. In the long term, therefore, the procedure does not lead to any impairment of organ function. Mucosectomies are most commonly performed in the gastrointestinal tract and in the esophagus or around the vocal fold. They are a much less complex and usually lower-risk procedure than the alternative of actual surgery. In the meantime, mucosectomy has become almost a standard procedure within Germany and especially Japan.
Function, effect, and goals
As a rule, mucosectomy is preceded by suspicion of a malignant tumor that has so far developed only superficially. The procedure is designed to ablate the mucosal area that appears suspicious as completely as possible. The tissue is then subjected to laboratory examination to determine whether it is malignant. In this context, mucosectomy is an in situ treatment procedure for early-stage carcinomas that have not yet grown beyond the mucosa. Especially tumors in the esophagus are removed via mucosectomy in Germany. In contrast, the more advanced method of endoscopic submucosal dissection is predominantly used for early gastric carcinomas. Compared with mucosectomy, it offers the possibility of removing the tumor “en bloc”. That is, the growth does not have to be cut through. For malignant tumors, this is considered a recognized surgical requirement. Indeed, when tumors are cut through, the operating physician may carry away tumor cells, which then begin to proliferate elsewhere. Endoscopic submucosal dissection is mainly used in Japan and, unlike mucosectomy, is not yet a standard procedure in Germany. This means that German physicians also usually treat early tumors in the gastrointestinal tract via mucosectomy. For this purpose, they perform gastrointestinal endoscopy. During this procedure, the patient lies on an examination couch and receives a sedative injection if desired. The patient’s pulse and oxygen saturation are constantly monitored during the upcoming procedure. A saline or adrenaline solution is injected submucosally into the patient during gastrointestinal endoscopy. This solution elevates the affected tissue. In some circumstances, however, the tissue area may be aspirated instead of injected submucosally. The affected tissue is removed with a monofilament electrical snare, and Haemoclips are used to prevent bleeding. A suction cap gives the attending physician a clear view during the operation. As a rule, the procedure takes ten to 30 minutes. The removed tissue is then sent to the laboratory and microscopically evaluated by a pathologist. In this way, the malignancy and stage of the tumorous process can be assessed.
Risks, side effects, and hazards
Mucosectomies are not painful for the patient. However, like gastrointestinal endoscopy, they can be considered uncomfortable. As risks, in rare cases there is infection, bleeding, or a hole in the mucosa. In case of sequelae such as pain, circulatory problems or shortness of breath, bleeding and fever, the patient must contact a doctor immediately to rule out life-threatening consequences.As a rule, however, life-threatening complications no longer occur in the course of mucosectomy today. In general, mucosectomy complications have a relatively low incidence of 1:1000 to 1:5000. In most cases, complications are related to the administration of a sedative. Without this sedative administration, the procedure is correspondingly safer because the anesthetic may cause allergic reactions, respiratory distress, or circulatory problems. In rare cases, the doctor penetrates too deeply into the tissue during mucosectomy. If this happens, emergency surgery may need to take place. Mucosectomies of the gastrointestinal tract, in particular, may require an accompanying special diet that addresses food intake for the next few weeks. In some cases, mucosectomies must be repeated several times to achieve the desired result. During the first few years after surgery, the patient has regular endoscopic follow-up of the affected area to monitor the healing process and to rule out recurrence of tumorous changes. Initially, an endoscopy is performed about every three months for this purpose. Later, this period becomes increasingly longer. If a sedative was given during the procedure, the patient is not allowed to drive machines or vehicles on the same day. If the follow-up examinations during the following year reveal disturbed or disturbing scarring, this complication may have to be compensated for by a follow-up operation. Because the procedure is a relatively new procedure, not too much can be reported on the long-term success of the procedure to date.
