Transanal endoscopic microsurgery in benign rectal tumors treatment

Abstract

The literature review concerning various minimally invasive surgical tmethods for benign rectal tumors treatment is given. Data from leading clinics suggests that currently the main methods of adenomas treatment, including large ones, are endoscopic electroexcision through a colonoscope (endoscopic mucosal resection and endoscopic submucosal dissection), local transanal excision of the tumor and transanal endoscopic microsurgery. In addition to these techniques, transrectal resection of the rectum and transabdominal surgical interventions is used for large rectal adenomas. Most authors assess the long‑term results of endoscopic techniques for the large rectal adenomas removal (endoscopic mucosal resection) as unsatisfactory due to a dramatically increased risk for relapse coused by single‑unit resection difficulty. The dissection technique in the submucosal layer requires a lot of time, technical tools and skills, and currently requires standardization for the rectal localisation. The authors attribute to the disadvantages of benign rectal neoplasms transanal excision the limitation of the method by application for adenomas in the lower and, in part, in the mid‑ampular rectal part, which makes it impossible to adequately remove the neoplasm when the proximal edge of the tumor is above 3 — 4 cm from the dentate line and, as a result, the occurrence of a large number of local recurrences. Comparative analysis of minimally invasive with open surgical methods of large rectal adenomas was not carried out due to the high invasiveness of the latter, dependence on anesthetic management, high probability of both surgical and anesthetic complications during surgery and in the postoperative period. The published studies’ results allow evaluating transanal endoscopic microsurgery as the most effective method for advanced benign rectal epithelial tumors treatment. Transanal endoscopic microsurgery has the optimal ratio between intervention radicalism and minimal invasiveness among the existing minimally invasive methods for rectal neoplasms, which is confirmed by significant international experience.