Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre

Mario Guerrieri,Monica Ortenzi,Maria Michela Cappelletti Trombettoni,Roberto Ghiselli,Indrit Kubolli

doi:10.4236/jct.2015.611108

Abstract

Aim: Transanal endoscopic microsurgery (TEM) is an effective, minimally invasive alternative approach to traditional surgery. This study reviews the characteristics of a series of patients affected by early rectal cancer and discusses the results of this treatment. Methods: From 1992 to 2014, 187 patients with rectal cancer staged as pT1 by preoperative endorectal ultrasound, computerized tomography and/or magnetic resonance imaging were treated by TEM at our institution. We analysed age, gender, size of lesion, distance from the anal verge, histological grading and stage. Furthermore we considered operative time, intra and post-operative complications and hospital stay. Patients were also enrolled in a tight follow-up for recurrence and survival. Results: There were no intraoperative complications or conversions to other procedures. There were minor complications (partial suture dehiscence, stool incontinence, rectal haemorrhage) in 24 patients (12.8%) and a major complication (perianal phlegmon) in one (1.5%). Two (5%) of the 40 patients with pT3 disease before neoadjuvant therapy experienced a local recurrence and one (2.5%) died for metastasis. Conclusion: TEM is a safe technique characterized by low morbidity and mortality and excellent oncological outcomes. These advantages, coupled with its ability to be applied to a strikingly high proportion of rectal tumours, suggest that it should be considered as the gold standard approach to early rectal cancer in accurately selected patients.

Highlights

Over the past few years, rectal cancer surgery has progressed at a fast pace, culminating in the development ofHow to cite this paper: Guerrieri, M., Ortenzi, M., Cappelletti Trombettoni, M.M., Kubolli, I. and Ghiselli, R. (2015) Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre
The evolution has benefited from concurrent advances in diagnostic imaging like transanal endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI)—which have been providing increasingly accurate preoperative staging—as well as in non-surgical approaches, radiotherapy (RT) and chemotherapy
No-surgical operative techniques for early rectal cancer therapy have been introduced over the past few years

Summary

Introduction

Over the past few years, rectal cancer surgery has progressed at a fast pace, culminating in the development ofHow to cite this paper: Guerrieri, M., Ortenzi, M., Cappelletti Trombettoni, M.M., Kubolli, I. and Ghiselli, R. (2015) Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre. Over the past few years, rectal cancer surgery has progressed at a fast pace, culminating in the development of. (2015) Local Excision of Early Rectal Cancer by Transanal Endoscopic Microsurgery (TEM): The 23-Year Experience of a Single Centre. Despite the effectiveness of the latter approaches, surgery remains the gold standard treatment for rectal cancer, and minimally invasive techniques have become its mainstay. Transanal endoscopic microsurgery (TEM) was developed by Gerhard Buess in 1983 [1]; 30 years on it is still considered as an innovative technique that affords radical yet minimally invasive tumour excision in selected patients. The current point of view is to consider local excision curative in T1 N0 rectal cancer without high risk features [2] and TEM, as we stated in our previous works, can be considered the best choice in these tumors [3]-[5]

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