Transanal endoscopic microsurgery for early rectal cancer: single center experience

Abstract

IntroductionThe use of transanal endoscopic microsurgery (TEM) is increasing due to the ability to perform minimally invasive local treatment with large full-thickness local excision under improved vision.AimTo evaluate the initial experience with TEM for early rectal cancer in a single center.Material and methodsFrom February 2010 to November 2013 a total of 20 patients underwent TEM for early rectal cancer. Nine were women and 11 men, age range 39 to 88 years (median: 71 years). The postoperative surveillance protocol, which includes rigid proctoscopy, carcinoembryonic antigen (CEA) and endorectal ultrasound every 3 months during the first 2 years, was applied to all patients after TEM.ResultsFinal histology revealed 14 (70%) lesions to be T1 and 6 (30%) T2 cancers. There were no postoperative complications. All 6 patients in the pT2 group and those in the pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 2 to 35 months (median: 21 months). There was one local recurrence (5%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, and for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free.ConclusionsIn our hands, TEM was an alternative to total mesorectal excision in patients with low-risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience

“…In conclusion, previous studies at our clinic had already shown TEM to be an alternative to the transanal approach when treating patients with benign and malignant rectal masses, and since those studies, it has become the procedure of choice for the treatment of patients with rectal tumors [ 28 29 ]. Acceptable short-term outcomes—low recurrence rates and low complication rates after the surgery—allow us to conclude that TEM is an effective and safe method for the treatment of patients with rectal tumors.…”

Novel combined approach in the management of non-healing solitary rectal ulcer syndrome – laparoscopic resection rectopexy and transanal endoscopic microsurgery

“…For the same reason, safe performance of STARR technique with clear resection margins was also very questionable. The TEM was therefore employed as the optimal surgical technique, allowing excellent access to rectal lesions located far away from the anal verge [ 14 ].…”

“…The TEM provides a safe and effective way of full thickness excision of the rectal wall with a 1-cm margin. The technique facilitates the surgical approach to rectal lesions and allows rectal resection with a clear and detailed view [ 14 , 15 ]. Excellent haemostasis can be achieved efficiently using ultrasonic dissection; the rectal wall defect is closed safely and precisely.…”