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Updated: May 30, 2026
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Published on: February 13, 2026
Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience
A S Kumar1, S M Sidani, K Kolli
1Division of Colon and Rectal Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA. askumarmd@gmail.com
Summary
Transanal endoscopic microsurgery (TEM) offers a safe and effective option for resecting rectal carcinoids, particularly after incomplete colonoscopic removal. This minimally invasive technique achieves negative margins and prevents recurrence.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Colorectal Surgery
Background:
- Rectal carcinoids frequently undergo incomplete resection via snare excision during colonoscopy.
- Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative with low morbidity.
- TEM enables full-thickness excision, improving the likelihood of achieving negative margins.
Purpose of the Study:
- To report the largest United States (US) experience with transanal endoscopic microsurgery (TEM) for rectal carcinoids.
- To evaluate the efficacy and safety of TEM in managing rectal carcinoids.
Main Methods:
- Prospective data collection and retrospective analysis of patients undergoing TEM for rectal carcinoids.
- Review of patient and tumor characteristics, operative/perioperative details, and oncological outcomes.
Main Results:
- Twenty-four patients underwent TEM over 12 years; 75% were for incomplete snare excisions.
- Despite prior incomplete resection, negative margins were achieved in all cases.
- No tumor recurrences were observed during the follow-up period.
Conclusions:
- Transanal endoscopic microsurgery (TEM) is effective and safe for rectal carcinoids <2 cm, with typical features, located >5 cm from the anal verge.
- TEM is suitable for both primary resection and salvage after incomplete colonoscopic excision.
- This approach minimizes the need for radical surgery for selected rectal carcinoid cases.
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