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Published on: February 12, 2022
[Possibilities of transanal endoscopic microsurgery: the experience of 202 operations]
Abstract:
Transanal endoscopic microsurgery (TEM/TEO) is a standard treatment for rectal adenomas but can also be used for selected malignant tumors. Rectal adenomas, selected adenocarcinomas and carcinoids were chosen for operations. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic CT (MRI). Two hundred and two patients [mean age of 62.4 ± 10.3 (33-86)] had TEO. The mean size ± SD of tumors was 3.2 ± 1.4 cm (0.6-8.0). Mean distance from anal verge and dental line was 7.1 ± 2.4 cm (2.5-14.0) and 4.6 ± 2.6 cm (0.5-12.0), respectively. Preoperative biopsy revealed: adenoma--156/202 (77.2%), adenocarcinoma--39/202 (19.3%) and carcinoid--7/202 (3.5%). The median operating time was 40 (20-180) min. Tumor-free margins were obtained in 200/202 (99%) operative specimens, 2/202 (1.0%) cases tumors were fragmented. Morbidity was 7/202 (3.5%). Pathological investigation revealed: adenoma in 109/202 (54.0%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 86/202 (42.5%), carcinoid in 5/202 (2.5%), neurilemoma in 1/202 (0.5%), neurofibroma in 1/202 (0.5%). One hundred and two patients had follow-up (95%). Median follow-up at 20 (1-41) months; 3/192 patients with adenocarcinoma, 1/192 patient with adenoma and 1/192 patient with carcinoid had local recurrence. Thus, transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.
Insights
Transanal endoscopic microsurgery (TEM) effectively treats rectal adenomas and selected cancers with high tumor-free margins and low recurrence rates. This minimally invasive approach demonstrates low morbidity, making it a valuable option for rectal lesion management.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Oncology
Context:
- Transanal endoscopic microsurgery (TEM) is an established technique for benign rectal adenomas.
- Its application in selected malignant rectal tumors is increasingly explored.
- Preoperative diagnostics include digital rectal examination, rectoscopy, colonoscopy, EUS, and pelvic CT/MRI.
Purpose:
- To evaluate the efficacy and safety of transanal endoscopic microsurgery (TEM) for rectal adenomas and selected malignant tumors.
- To assess tumor-free margins, morbidity, and local recurrence rates following TEM.
Summary:
- Two hundred and two patients underwent TEM for adenomas (77.2%), adenocarcinomas (19.3%), and carcinoids (3.5%).
- Tumor-free margins were achieved in 99% of cases, with low overall morbidity (3.5%).
- Follow-up revealed low local recurrence rates for adenomas, adenocarcinomas, and carcinoids.
Impact:
- Transanal endoscopic microsurgery (TEM) offers a safe and effective minimally invasive treatment option for rectal adenomas and selected early-stage rectal cancers.
- The procedure is associated with high rates of complete tumor resection and low recurrence, supporting its role in rectal lesion management.
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