Transanal Endoscopic Microsurgery for Local Excision of Rectal Lesions: Is There a Learning Curve

Abstract

Background: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for the local resection of benign and stage T1 rectal lesions in selected patients, associated with lower morbidity and mortality rates than open surgery. We present our initial results and assess whether experience influences outcome after TEM. Methods: This was a prospective descriptive survey. All patients undergoing TEM for tubulovillous adenoma or carcinoma between 2002 and 2007 were included. Results: A total of 105 patients were included. Median age was 68 years. Median distance of the lesion from the anal verge was 7.0 cm; median operating time was 90 min. In 10 patients, the peritoneum was opened. Six procedures were converted to (low) anterior resections. Postoperative staging revealed 77 tubulovillous adenomas, 22 stage T1, 5 stage T2 and 1 stage T3 carcinomas; tumor resection was radical in 86%. The postoperative complication rate was 7.6%. Length of hospital stay, operating time and complications significantly diminished over time. After a median follow-up of 27 months, 8 recurrences occurred (7.6%). Conclusion: TEM is a safe technique with low morbidity and recurrence rates. Over time, experience leads to a reduction in operation time, lenght of patients’ hospital stay and complication rate. TEM remains the treatment of choice for benign lesions and stage T1 rectal carcinomas in selected patients.

Transanal endoscopic microsurgery: a review

“…14,17 Also, a number of studies have reported significantly decreased duration of surgery for TEM compared with radical resection, with reductions ranging from 46 to 140 minutes. Most patients who undergo TEM experience short hospital stay and early return to routine activities, even after resection of very large lesions, often with full thickness excision.…”

Rectal Carcinoma: Multi-Modality Approach in Curative Local Treatment of Early Rectal Carcinoma

“…Study by Heintz et al is difficult to interpret due to inclusion of patients who had inadequate local surgery. TEM is a safe technique with low morbidity and recurrence rates (Koebrugge et al, 2009). Experience over times has led to a reduction in operation time, length of patients' hospital stay and complication rate.…”

Transanal minimally invasive surgery (TAMIS) with a GelPOINT® Path for lower rectal cancer as an alternative to transanal endoscopic microsurgery (TEM)

“…TEM has also become a valuable option in selected patients with malignant rectal disease, in whom it may provide an acceptable oncological outcome with minimal postoperative morbidity and an improved functional outcome compared with standard radical resection (8,9). However, nearly 30 years after the introduction of TEM, this transanal platform has not achieved widespread adoption due to the cost and the complexity of the instruments, the steep learning curve and the requirement of specialized training to master the operation (10,11).…”