Transanal endoscopic surgery in rectal cancer

Area of Science:

• Colorectal surgery
• Surgical oncology
• Gastroenterology

Background:

• Total mesorectal excision (TME) is standard for rectal cancer but has high complication rates.
• Transanal endoscopic microsurgery (TEM) provides minimally invasive access for rectal tumor removal.
• Accurate preoperative staging is vital for determining the suitability of local surgery.

Purpose of the Study:

• To describe the standard technique, equipment, and limitations of Transanal endoscopic microsurgery (TEM).
• To discuss the application of TEM for rectal adenomas and early-stage adenocarcinomas (T1).
• To evaluate the role of TEM in conjunction with neoadjuvant therapies for rectal cancer.

Main Methods:

• Description of the standard Transanal endoscopic microsurgery (TEM) technique.
• Review of equipment used in TEM procedures.
• Analysis of indications and limitations for TEM in rectal cancer treatment.

Main Results:

• TEM allows sphincter preservation and access to rectal tumors up to 20 cm from the anal verge.
• Local surgery is indicated for T1 rectal tumors, but recurrence rates vary based on tumor characteristics.
• TEM for rectal adenomas should follow adenocarcinoma protocols due to potential infiltration.
• TEM combined with chemoradiotherapy shows encouraging results for T2N0M0 adenocarcinoma, though evidence is limited.

Conclusions:

• TEM is a viable local treatment option for selected rectal tumors, offering sphincter preservation.
• Accurate staging and histological assessment are critical for optimizing TEM outcomes and minimizing recurrence.
• Further research is needed to establish the long-term efficacy and optimal role of TEM, particularly with neoadjuvant therapies.