Transanal endoscopic microsurgical excision of rectal tumors: Indications and results

Abstract

Transanal endoscopic microsurgery (TEM) allows local excision of rectal tumors located 4 to 18 cm above the anal verge. The technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical aspects of the approach, and the stringent patient selection criteria. The aim of this prospective, descriptive study was to analyze the currently accepted indications for TEM and to evaluate the use of this procedure for treating rectal cancer. Over a 4-year period 50 patients aged 31 to 86 years (mean 64 years) underwent TEM for treatment of rectal tumors located 12 cm above the anal verge (range 4-18 cm). The local complication rate was 4%. Altogether, 76% of lesions were benign, and 24% were T1 and T2 tumors. Of 12 cancer cases, 4 required reoperation by total mesorectal resection; the other 8 are currently under follow-up management. Over the follow-up period of 30.6 months (range 11-54 months) the recurrence rate of T1 tumors was 8.3%. TEM is a minimally invasive surgical technique that may benefit a small, specific population of patients with rectal tumors. Compared with conventional transanal resection, TEM provides superior exposure of tumors higher up in the rectum (i.e., up to 18 cm from the anal verge). The greater precision of resection combined with low morbidity (10%, relative to that of anterior resection) and short duration of hospitalization (5.5 days) make this technique a reliable and in some cases more effective surgical approach than laparotomy and low anterior resection.

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

“…Other studies have also demonstrated good results with low recurrence and high survival for selected pT1N0 rectal adenocarcinomas treated by TEM alone 2,4,8,13,20,21,36 . In the advent that pathological examination reveals a pT1 lesion with unfavorable features or a more advanced lesion the authors recommend complementary treatment with radical surgery and/or CMT.…”

Transanal endoscopic operation: a new proposal

“…[38][39][40][41] Because of the necessity of having specific instruments and also the particular technical aspects, this method demands good training for the obtention of satisfactory results. [42][43][44] It was described that in 11 tumors located up to 4 cm of the anorectal line, a surgical conversion was necessary because of technical difficulties. 45 Due to two important disadvantages: first the high costs, taking into account the limitation of the equipment use and second, technical difficulties to perform the technique with ability and efficiency, the procedure has not achieved wide acceptance and popularity.…”

Transanal Endoscopic Operation - A New Proposal

“…Nevertheless, these techniques demand experience and, in consequence, must be performed in reference centers where a larger number of patients are available, facing that the surgeon training is mandatory and the small frequency of the indications is a reality [41][42][43][44]. Because of the necessity of having specific instruments and also the particular technical aspects, this method demands good training for the obtention of satisfactory results [45][46][47]. It was described that in 11 tumors located up to 4 cm of the anorectal line, a surgical conversion was necessary because of technical difficulties [48].…”