Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience.

Abstract

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75%) of the subjects were male with a mean age of 71 ± 10years (range 49-90years) and 19 (48%) patients were ASA 3 and 4. Nineteen (48%) of cancers were pT1, eighteen (45%) were pT2, two (5%) were pT3 and one was yPT0. Mean specimen size was 66 ± 20mm (range 33-120mm) with a mean polyp size of 41 ± 24mm (range 18-110mm). The mean cancer size was 24 ± 13mm (range 2-50mm). Average distance from the anal verge was 70 ± 37mm (range 10-150mm), and the mean operating time was 72 ± 22min (range 40-120min), with an average blood loss of 28 ± 15ml (range 10-50ml). Median hospital stay was 2 ± 1days (range 1-7days). Complete excision (R0) was achieved in 37 (93%) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13 ± 11months, range (3-40months) Local recurrence occurred in two (5%) patients, both underwent redo TEM. Twelve (30%) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.