Transanal Local Excision or Endoscopic Dissection for Benign and Large Lesions of the Rectum

Abstract

Since the introduction of transanal endoscopic microsurgery, local excision of “early” rectal lesions has offered the possibility to reduce the invasiveness of treatment for the limited disease. Flexible endoscopy techniques allow today different alternatives consisting of endoscopic mucosal resection or endoscopic submucosal dissection. The first is a straightforward and relatively easy technique, but it prevents a correct pathological staging of the lesion due to fragmentation and the verification of disease-free margins. The second relies on operators' audacity depending on their increasing experience due to the limited progress in technology. What is the preferable technique today is questionable. All the methods have pros and cons. The future certainly will see the use of ideal systems, allowing the possibility of precision surgery for partial- or full-thickness excision, depending on intraoperative findings, and the extension above the rectosigmoid junction. Miniaturized flexible robotic devices may represent the solution for both issues.

The Outcome of Local Excision of Rectal Adenomas with High-Grade Dysplasia by Transanal Endoscopic Microsurgery: A Single-Center Experience

“…The approach to the surgical resection of rectal lesions when endoscopic polypectomy is unsuccessful has historically been radical rectal resection with total mesorectal excision. Alternatively, a number of transanal excision (TAE) methods have proven much less morbid and oncologically safer for benign lesions and early cancer [ 9 ]. One such method is transanal endoscopic microsurgery (TEM).…”

“…TEM is an endoscopic local excision technique, which enables a more precise and high-quality excision of selected rectal lesions [ 10 ]. Since its introduction a few decades ago, this technique has proved its superiority over the traditional TAE for benign rectal lesions in terms of the morbidity and quality of specimens [ 9 ]. Meanwhile, for early rectal cancer compared to radical surgery, TEM has better functional outcomes and appears to have comparable long-term survival rates [ 11 ].…”