Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre

Abstract

Aim: Transanal endoscopic microsurgery (TEM) is an effective, minimally invasive alternative approach to traditional surgery. This study reviews the characteristics of a series of patients affected by early rectal cancer and discusses the results of this treatment. Methods: From 1992 to 2014, 187 patients with rectal cancer staged as pT1 by preoperative endorectal ultrasound, computerized tomography and/or magnetic resonance imaging were treated by TEM at our institution. We analysed age, gender, size of lesion, distance from the anal verge, histological grading and stage. Furthermore we considered operative time, intra and post-operative complications and hospital stay. Patients were also enrolled in a tight follow-up for recurrence and survival. Results: There were no intraoperative complications or conversions to other procedures. There were minor complications (partial suture dehiscence, stool incontinence, rectal haemorrhage) in 24 patients (12.8%) and a major complication (perianal phlegmon) in one (1.5%). Two (5%) of the 40 patients with pT3 disease before neoadjuvant therapy experienced a local recurrence and one (2.5%) died for metastasis. Conclusion: TEM is a safe technique characterized by low morbidity and mortality and excellent oncological outcomes. These advantages, coupled with its ability to be applied to a strikingly high proportion of rectal tumours, suggest that it should be considered as the gold standard approach to early rectal cancer in accurately selected patients.

Role of local excision in the management of rectal cancer: what does the future hold?

“…Any local technique which attains this goal should produce equivalent results. Recent improvements in techniques for transanal excision have consistently shown that in most surgeons' hands traditional transanal excision is inferior to newer techniques [9,10]. For that reason, if transanal tumor excision is planned, an advanced technique with rectal insufflation, magnified vision, and precise surgical instrumentation should be used.…”