Transanal endoscopic microsurgery for rectal neoplasms. How I do it.

Area of Science:

• Colorectal Surgery
• Minimally Invasive Procedures
• Oncologic Surgery

Background:

• Transanal endoscopic microsurgery (TEM) has transformed transanal surgery for rectal lesions.
• It is the standard for large sessile rectal adenomas.
• TEM is a potential treatment for early rectal cancer.

Purpose of the Study:

• To evaluate the safety and efficacy of TEM.
• To assess oncologic and functional outcomes of TEM.
• To determine the role of TEM in treating rectal adenomas and early cancers.

Main Methods:

• Full-thickness rectal wall excision.
• Transanal specimen retrieval.
• Disinfection and transanal closure with sutures and clips.

Main Results:

• Peritoneal perforation does not impact outcomes.
• Morbidity is 2-15%, often managed conservatively.
• Local recurrence for adenomas is ~6%, manageable with TEM.
• Effective for pT1 sm1 rectal cancer; high risk for pT1 sm2-3 and pT2.
• TEM does not affect anorectal function or quality of life.

Conclusions:

• TEM is a safe procedure for benign rectal lesions.
• TEM yields excellent functional and oncologic outcomes for selected early rectal cancers.