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Transanal endoscopic microsurgery for rectal cancer.

A Slater1, M Betts1, E M Anderson1

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Summary

Total mesorectal excision (TME) is standard for rectal cancer but causes complications. Transanal endoscopic microsurgery (TEM) offers fewer complications and is an alternative for select cases.

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Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Gastroenterology

Background:

  • Total mesorectal excision (TME) has been the gold standard for rectal cancer surgery since the 1980s.
  • TME involves removing the rectum and surrounding mesorectal fat, reducing local recurrence by excising lymph nodes.
  • Despite its efficacy, TME is linked to significant morbidity, including incontinence, stoma formation, and sexual/bladder dysfunction.

Purpose of the Study:

  • To outline the transanal endoscopic microsurgery (TEM) technique for rectal cancer.
  • To detail the indications, imaging findings, and potential complications associated with TEM.
  • To present TEM as a less morbid alternative to TME in specific rectal cancer scenarios.

Main Methods:

  • Review of the transanal endoscopic microsurgery (TEM) surgical technique.
  • Analysis of patient selection criteria and indications for TEM.
  • Documentation of characteristic imaging appearances and known complications of TEM.

Main Results:

  • TEM allows for local excision of rectal tumors, potentially avoiding radical resection.
  • The technique is associated with a lower complication rate compared to TME.
  • Specific indications and contraindications for TEM were identified.

Conclusions:

  • Transanal endoscopic microsurgery (TEM) is a viable alternative to TME for selected rectal cancers.
  • TEM offers a potentially less invasive approach with reduced morbidity.
  • Understanding TEM's technique, indications, and complications is crucial for its appropriate application.