Transanal endoscopic microsurgery: experience with 75 rectal neoplasms

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Transanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique for rectal lesions.
• Experience with TEM for both benign and malignant rectal tumors is valuable for establishing its efficacy and safety profile.

Purpose of the Study:

• To report the single-institution experience with transanal endoscopic microsurgery (TEM) for patients diagnosed with benign and malignant rectal tumors.
• To evaluate the safety, efficacy, and outcomes of TEM in a diverse patient cohort.

Main Methods:

• A retrospective review of 75 patients who underwent TEM for benign (46) or malignant (29) rectal tumors between January 1992 and April 1998.
• Tumors were located 3 to 18 cm from the dentate line, with a mean follow-up of 38 months.

Main Results:

• For benign tumors, 6.5% required conversion to radical surgery, and 9% experienced recurrence, managed effectively with repeat TEM or radical surgery.
• For malignant tumors (T1-T3), 18% had recurrence, with management including repeat TEM, radical surgery, or laser ablation. No cancer-related deaths occurred.
• Postoperative complications were minor, with one operative mortality in a high-risk patient. Rectourethral fistula and transient fecal soiling were noted.

Conclusions:

• Transanal endoscopic microsurgery (TEM) is a safe, precise, and well-tolerated technique, even in high-risk patients.
• TEM is a viable option for benign rectal tumors and selected early-stage malignant rectal neoplasms.
• The procedure demonstrates a favorable safety profile with manageable complications and good long-term outcomes.