Abstract
BackgroundTransanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter. The present retrospective analysis reports the course of observation after local excision of adenomas and T1 low-risk carcinomas using transanal endoscopic microsurgery.MethodsIn a retrospective analysis we examined data on 279 patients for local recurrence. A total of 144 patients had a rectal adenoma (n = 103) or a R0 resection of low-risk T1 carcinomas (n = 41). In this collective, we also examined parameters concerning perioperative management, complications, intraoperative blood loss and duration of hospital stay.ResultsPatients with adenoma were on average 64.9 (range 37 to 90) years old; 83.5% of the adenomas were located 3 to 11 cm from the anocutaneous line. In adenoma patients the recurrence rate was 2.9% for an observation period of 21.8 months. The postoperative course was without any complications in 98.1% of patients.Patients with T1 low-risk carcinoma were 64.6 (range 30 to 89) years old. In all cases, an R0 resection could be performed. The recurrence rate was 9.8% for an observation period of 34.4 months. In this group the postoperative course was free of complications in 97.6% of patients.ConclusionsThe high efficacy of transanal endoscopic microsurgery ensures minimally invasive treatment of adenomas and low-risk T1 carcinomas with low complication rates and a low rate of therapeutic failure.
Highlights
Transanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter
The incidence rate of colorectal cancer in Europe is about 0.00025% a year; 29% of these carcinomas are located in the rectum [1]
Patients Overall 279 patients with rectal neoplasm had a local excision with transanal endoscopic microsurgery (TEM) in our sections in the Olympiapark-Klinik Munich and the Helios-Klinik Müllheim between 1998 and 2006
Summary
Transanal endoscopic microsurgery as a local therapy option for rectal neoplasms is a tissue-sparing technique that protects the anal sphincter. The present retrospective analysis reports the course of observation after local excision of adenomas and T1 low-risk carcinomas using transanal endoscopic microsurgery. There are different local excision techniques such as the methods of Mason and Parks [4,5]. The literature reports the recurrence rate for transanal polypectomy using Parks’ method to be between 16 and 20% [14,15]. A recrudescence rate of 3.3% is reported for the Mason method [14], with a morbidity rate of 30.7% because of fistulas and bleeding [17]. A high degree of wound infections, fistulas and a high mortality rate are reported for these methods [18].
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