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Efficacy of transanal endoscopic microsurgery in the management of rectal polyps
Cameron Platell1, Eva Denholm, Gregory Makin
1Colorectal Unit, Fremantle Hospital, Fremantle, Western Australia, Australia. cplatell@cyllene.uwa.edu.au
Background And Aim:
Transanal endoscopic microsurgery (TEM) was a technique developed to allow the excision of adenomas and early-stage cancers from the rectum and distal sigmoid colon. The aim of this project was to prospectively study surgical morbidity, mortality and the local recurrence rate of all patients treated with this technique.
Methods:
All patients undergoing TEM were prospectively evaluated. Endpoints to assess the surgical morbidity and mortality were defined before the study commenced. All patients underwent regular follow up to determine treatment efficacy in terms of the local recurrence rate and survival.
Results:
The study involved 113 patients, with a mean age of 69 years (standard deviation 14 years, range 30-94 years), and a male to female ratio of 1.4:1. The mean polyp area was 20.5 cm(2) (range 1-169 cm(2)) and the mean height above the anal verge was 9.5 cm (range 4-25 cm). Histology of the tumors found 62 adenomas, 20 carcinomas in situ, and 31 adenocarcinomas. There were no unplanned returns to theater or postoperative deaths. Four patients required readmission within 30 days because of bleeding, and nine patients underwent more radical surgical procedures following histological evaluation of the resected specimens. During a mean follow up of 1.5 +/- 0.8 years (maximum 3.2 years), there have been two recurrences of villous adenomas. The actuarial local recurrence rate at 2 years is 2.4% (95% confidence interval 0.8-4.0%).
Conclusion:
TEM was demonstrated to be a safe surgical procedure, and early follow up has shown it to be an efficacious treatment for benign rectal adenomas and early rectal cancers.
Insights
Transanal endoscopic microsurgery (TEM) is a safe and effective procedure for removing rectal adenomas and early cancers. This study shows a low local recurrence rate of 2.4% at two years, demonstrating its efficacy.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Oncology
Background:
- Transanal endoscopic microsurgery (TEM) is a specialized technique for excising rectal and distal sigmoid colon lesions.
- The study aimed to evaluate the safety and efficacy of TEM in a prospective cohort.
Purpose of the Study:
- To prospectively assess surgical morbidity and mortality associated with TEM.
- To determine the local recurrence rate and survival outcomes following TEM treatment.
Main Methods:
- 113 patients undergoing TEM were prospectively evaluated.
- Predefined endpoints for morbidity and mortality were established.
- Regular follow-up was conducted to assess local recurrence and survival rates.
Main Results:
- The study included 113 patients (mean age 69 years) with rectal adenomas, carcinomas in situ, and adenocarcinomas.
- No postoperative deaths or unplanned returns to surgery occurred.
- The 2-year actuarial local recurrence rate was 2.4% (95% CI 0.8-4.0%), with two cases of villous adenoma recurrence.
Conclusions:
- Transanal endoscopic microsurgery (TEM) is a safe surgical option.
- Early follow-up indicates TEM is effective for benign rectal adenomas and early-stage rectal cancers.
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