The transanal endoscopic microsurgery procedure: standards and extended indications

Area of Science:

• Colorectal Surgery
• Minimally Invasive Procedures
• Oncology

Background:

• Transanal endoscopic microsurgery (TEM) was initially developed for benign rectal adenomas.
• TEM has shown safety and efficacy for benign conditions, exceeding traditional local excision.
• Its application has expanded to include early-stage rectal cancer, sparking debate on oncological safety.

Purpose of the Study:

• To evaluate the oncological safety and efficacy of TEM for rectal adenomas and early rectal cancer.
• To discuss patient selection criteria for TEM in rectal cancer cases.
• To review functional outcomes and quality of life after TEM procedures.

Main Methods:

• Review of existing literature on TEM for rectal adenomas and cancer.
• Analysis of retrospective case series and prospective studies on TEM outcomes.
• Assessment of functional results and quality of life data post-TEM.

Main Results:

• TEM is safe and effective for benign rectal adenomas.
• Oncological safety for rectal cancer, particularly high-risk T1 and deeper tumors, remains controversial.
• Preoperative radiochemotherapy may improve outcomes for local excision in some rectal cancer cases, but larger trials are needed.
• TEM does not result in permanent anorectal functional impairment or reduced quality of life.

Conclusions:

• TEM is a viable option for benign rectal adenomas.
• Careful patient selection is crucial for TEM in rectal cancer.
• Further prospective multicenter trials are required to definitively establish TEM's role in rectal cancer treatment.
• TEM offers favorable functional outcomes and quality of life for patients.