Transanal endoscopic microsurgery: a New Zealand experience

Area of Science:

• Colorectal Surgery
• Minimally Invasive Procedures
• Oncology

Background:

• Transanal endoscopic microsurgery (TEMS) is an established alternative to radical surgery or endoscopic mucosal resection for rectal neoplasms.
• TEMS offers reduced morbidity and mortality compared to total mesorectal excision.
• TEMS demonstrates a lower local recurrence rate than endoscopic mucosal techniques.

Purpose of the Study:

• To evaluate the safety and efficacy of Transanal endoscopic microsurgery (TEMS) for rectal neoplasms.
• To assess complication rates and local recurrence following TEMS.
• To compare TEMS outcomes with radical resection and endoscopic mucosal resection.

Main Methods:

• Retrospective data collection of TEMS procedures performed between 2010 and 2015.
• Data sourced from Waikato District Health Board, New Zealand, and national patient records.
• Analysis of 137 procedures, including follow-up data.

Main Results:

• A total of 137 TEMS procedures were performed, with 66.4% for benign lesions.
• Overall complication rate was 15.3%, with only 3.6% being Clavien-Dindo grade III.
• Local recurrence rate for benign lesions was 5.1%.

Conclusions:

• TEMS is a safe alternative to radical resection for sessile rectal lesions.
• Close endoscopic follow-up is advised, particularly for incomplete margins.
• TEMS yields good results for selected early malignant lesions, outperforming endoscopic mucosal resection and transanal excision.