Colorectal 10

Abstract

Aims: The role of local resection for benign rectal disease is well established, however, controversy still exists regarding its use in the treatment of malignant tumours. The aim of this study is to evaluate the role of Transanal Endoscopic Microsurgery (TEM) in the management of rectal tumours, in particular cancers. Methods: A total of 56 successive patients, mean age of 68 (range 37–91) years, underwent TEM by a single surgeon for rectal tumours over a 5-year period. Data were collected prospectively and reviewed with regards to diagnosis, TNM stage, length of operation and hospital stay, resection margins and recurrence rates. Results: Mean follow up was 21 months (range 3–60). 37 patients had benign rectal tumours and 19 had cancers of which 7 were T1, 9 T2, and 3 were T3. Mean length of surgery was 83 min (range 43–180) and mean hospital stay was 3.6 days (range 1–10). Margins were clear in 54 patients (96 per cent). Involved margins were observed in one patient with benign disease and one patient with rectal carcinoma, who had a palliative resection and died of metastatic disease. Hospital mortality was zero and only minor morbidity was observed in 23 per cent, which included bleeding, transient faecal incontinence and urinary retention. Recurrence rates for T1 and T2 tumours were 0 and 43 per cent, respectively. Conclusions: TEM for both benign and malignant disease is safe with zero mortality and low morbidity. However, its use in the surgical management of rectal cancer should be limited to those with early disease (T1) or for palliation.