Transanal Endoscopic Surgery for Rectal Cancer

TAMIS with partial excision of mesorectum and primary closure of rectal wound using vloc

“…In relation to costs, contrasting results have also been described in relation to the different methods of TES, with these reports: TEO D 1920, TEM D 2310 and TAMIS D 2220. 14 A recent review 2 found that 390 procedures had been described using TAMIS, the average lesion size was 3.1 cm, the average distance from the anal margin was 7.6 cm, positive margins occurred in 4.3%, and fragmentation of surgical specimens in 4.1%. Conversion was reported in 2.3% of cases.…”

Current status of local treatment for early rectal cancer in Japan: a questionnaire survey by the 81st Congress of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) in 2014

“…A transanal surgcial approach was chosen in almost all patients for LE along with conventional technique in 80 (80.8 %), MITAS in 14 (14.1 %), and TEM in 5 (5.1 %) in Period A. Even though TEM and MITAS provide access to more proximal tumors than does the conventional technique [6,17], the rate of both techniques decreased from MITAS in 23.8 % and TEM in 23.6 % according to the [19], which additionally cost approximately €1000 per procedure. Cost-benefits analysis of novel techniques should be addressed in further studies.…”

Submucosal dissection has advantages over full‐thickness transanal endoscopic microsurgery in selected rectal lesions

“…A review of the literature comparing TEM with primary TME in the management of T1/T2 rectal cancer suggests a higher risk of local recurrence with TEM alone, and recurrence rates for TEM alone have been reported as high as 20.5% for T1 and 35% for T2 cancers . Local excision methods such as TEM are generally not recommended for T2 and more invasive cancers, although the use of neoadjuvant/adjuvant therapy is being explored . With T1 lesions, however, it has been proposed that predictors of lymph node involvement and recurrence such as depth of submucosal invasion, differentiation grade and lymphovascular invasion can be used to distinguish between low‐risk lesions suitable for TEM alone, and higher‐risk lesions requiring further treatment post‐TEM .…”

“…However, there is still debate whether TEM alone provides outcomes similar to the current gold standard for rectal cancers, which is total mesorectal excision (TME). Evolving evidence suggests that with careful selection and possible incorporation of neoadjuvant or adjuvant chemoradiotherapy this may be the case . The minimally invasive approach of TEM with decreased operative time and post‐operative stay with low complication rates suggests many advantages to TME, which is associated with considerable morbidity and mortality.…”