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Transanal endoscopic microsurgery.

M Morino1, A Arezzo, M E Allaix

  • 1Digestive, Colorectal, Oncologic and Minimally Invasive Surgery, Department of Surgical Sciences, University of Turin, corso Dogliotti 14, 10126 Turin, Italy. mario.morino@unito.it

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Transanal endoscopic microsurgery (TEM) offers a minimally invasive approach for rectal cancer, providing precise dissection and low recurrence rates. Current indications focus on early-stage rectal cancers, with ongoing research for more advanced cases.

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Oncologic Surgery

Background:

  • Transanal endoscopic microsurgery (TEM) has evolved significantly over 30 years.
  • TEM revolutionized transanal surgery for rectal adenomas and early rectal cancer.
  • Its role in combination therapies for invasive cancer is under investigation.

Purpose of the Study:

  • To describe the indications, preoperative work-up, surgical technique, postoperative management, and long-term results of TEM.
  • To highlight TEM's effectiveness in treating benign and early-stage malignant rectal neoplasms.
  • To discuss the current and potential future applications of TEM in rectal cancer treatment.

Main Methods:

  • Review of a 20-year experience with transanal endoscopic microsurgery.
  • Description of surgical technique, preoperative staging, and postoperative care.
  • Analysis of outcomes for patients treated with TEM for rectal neoplasms.

Main Results:

  • TEM allows precise dissection with enhanced visualization, leading to low recurrence rates.
  • It is indicated for benign rectal neoplasms and pT1 sm1 malignant rectal neoplasms.
  • T1 sm2-3 and T2 lesions require further investigation in prospective trials.

Conclusions:

  • TEM is a valuable technique for selected rectal neoplasms, offering curative treatment with low morbidity.
  • Accurate preoperative staging is crucial for patient selection.
  • Referral to experienced centers is recommended for patients with clear indications for TEM.