Abstract
Completion proctectomy following transanal endoscopic microsurgery for early rectal cancer
Highlights
Transanal endoscopic microsurgery (TEM) was first introduced in 1984 by Buess et al.[1] as a minimally invasive surgical technique for the resection of large rectal adenomas
With TEM technique, a full-thickness en bloc excision is possible in the entire rectum, which may be technically difficult by other local procedures such as transanal excision (TAE)
Due to abovementioned advantageous attributes, the use of TEM for early rectal cancer is considered a viable option in selected patients, and may be offered to patents with lesions pre-operatively staged as T1N0, with tumor diameter < 4 cm involving less than 30% of the rectal wall circumference, and no histological risk factors[16,17,18,19,20]
Summary
Transanal endoscopic microsurgery (TEM) was first introduced in 1984 by Buess et al.[1] as a minimally invasive surgical technique for the resection of large rectal adenomas. For patients with tumors in the lower part of the rectum, local excision by TEM may offer a chance for preserved bowel continuity and avoidance of rectal amputation with subsequent consequences. In terms of oncological results, local excision of early rectal cancer (pT1) by TEM has equivalent outcomes to radical resection[10,11,13,14]. Due to abovementioned advantageous attributes, the use of TEM for early rectal cancer is considered a viable option in selected patients, and may be offered to patents with lesions pre-operatively staged as T1N0, with tumor diameter < 4 cm involving less than 30% of the rectal wall circumference, and no histological risk factors[16,17,18,19,20]. Unexpected malignancy is reported in 18%43% of preoperatively assumed benign lesions in the rectum[9,26,27,28]
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