Early rectal cancer: Can transanal endoscopic microsurgery (TEM) become the standard treatment?

Abstract

Aim. Transanal endoscopic microsurgery (TEM) is a main treatment technique for rectal adenomas, but can also be used for selected malignant tumors. This study presents TEM experience. Methods. The study enrolled patients with rectal adenomas, and selected adenocarcinomas. Preoperative work-up included: digital rectal examination, rectoscopy with biopsy, colonoscopy, EUS, pelvic MRI. Results. Three hundred and thirty patients [mean age of 61,4±10 (33-88)] underwent TEM. The mean size ± SD of tumors was 3.2±1.2 cm (0.6-10.0). Mean distance from anal verge was 6.7±2.6 cm (2.0-14.0). Preoperative biopsy revealed: adenoma 263/330 (79,7%), adenocarcinoma 67/330 (20,3%). The median operating time was 40 (15-220) min. Tumor-free margins were obtained in all operative specimens. In 5/330 (1.5%) cases tumors were fragmented. The morbidity rate was 19/330 (5.7%). Pathological investigation revealed: adenoma in 192/330 (58.1%) cases, adenocarcinoma stage Tis, T1, T2 and T3 in 138/330 (41.9%). Median follow-up lasted for 24 (1-57) months. Five patients (2.0%) with adenoma and four patients (5.2%) with adenocarcinoma had local recurrence. Conclusion. Transanal endoscopic microsurgery for rectal adenomas and selected malignant tumors is associated with low morbidity and low recurrents rates.