The indications and complications of transanal endoscopic microsurgery

Abstract

Objective To investigate the indications and complications of transanal endoscopic microsurgery(TEM). Methods In order to analyze the main indications and frequent complications of TEM in the management of rectal lesions, clinical data of 135 patients with rectal lesions treated using TEM between May 2011 and May 2014 were summarized retrospectively. Results All the 135 patients were performed TEM successfully.Surgical procedures included the full-thickness excision(115 cases)and the submucosal excision with partial muscular layer excision(20 cases). The average operating time was 66.5±25.0(range, 25~120)min.The mean operative blood loss was 10.5±5.5(range, 3~50)ml.The postoperative pathological examination identified retcal adenomas in 60, carcinomatous changes of adenomas(pTis)in 10, early rectal adenocarcinomas(pT1)in 11, advanced rectal adenocarcinomas(pT2)in 10, pathological complete response(ypT0)after preoperative chemoradiation in 2, rectal carcinoids or their residual lesions after endoscopic resection in 24, rectal gastrointestinal stromal tumor in 5, leiomyoma in 1, nontumorous polyps in 10, and rectal endometriosis in 2.Surgical margins of all specimens were clear.Three patients with the upper anterior rectal neoplasms happened entrance into the peritoneal cavity during full-thickness excision by TEM, and all peritoneal entries were closed transanally via endoscope without developing peritonitis or pelvic infection.Postoperative complications included anal hemorrhage in 2, pulmonary infection in 1, urinary infection in 1, and urinary retention in 1.The incidence of complications was 5.9%(8/135). The average postoperative stay was 2.5±1.2(range, 2~8)d.With a mean follow-up period of 15.5(6~36)months, no tumor recurrence or metastasis was observed. Conclusions The localized rectal neoplasms suitable for local excision are the main indications of TEM.TEM is a safe and effective procedure to treat rectal cancer in selected patients without evidence of nodal involvement, but the scientific evidence remains limited at present.As a kind of minimally invasive surgery with fewer complications, TEM is now considered as the first choice of procedure for rectal local excision. Key words: Anal canal; Surgical procedures, minimally invasive; indication; complication