Transanal Endoscopic Microsurgery (TEM) for Rectal Neoplasms

Manuel Ferrer-Márquez,Ángel Reina-Duarte,Ricardo Belda-Lozano,Antonio Álvarez-García,Francisco Rubio-Gil

doi:10.4236/ss.2012.36057

Abstract

Introduction: The abdominal approach for the treatment of rectal tumors is associated with a considerable rate of morbidity. Transanal Endoscopic Microsurgery (TEM) is an alternative technique that is less invasive than radical surgery, and therefore has a lower associated morbidity. Moreover, with proper patient selection, TEM presents oncological outcomes comparable to radical surgery. The aim of this study is to review our results obtained with TEM and discuss its role in the treatment of malignant rectal lesions. Patients and Methods: A prospective descriptive study from June 2008 until February 2011. The indications for TEM were: early rectal neoplastic lesions (T1N0M0) with good prognostic factors; neoplastic lesions in more advanced stages in selected patients (high surgical risk, refusal of radical surgery or stoma, and palliative intention). Results: Resection by TEM was performed on 19 patients. The average hospital stay was 5.7 days with an associated morbidity of 16.7%. R0 resection was 88.8%. During the follow-up of 15 (3 - 31) months, no recurrence has been shown. Conclusions: TEM is a safe and effective procedure for the treatment of selected early malignant rectal lesions and is associated with low morbidity. It is a therapeutic strategy based on a multidisciplinary team, careful patient selection, an audited surgical technique and a strict follow-up protocol.

Highlights

The abdominal approach for the treatment of rectal tumors is associated with a considerable rate of morbidity
Transanal Endoscopic Microsurgery (TEM) is an alternative technique that is less invasive than radical surgery, and has a lower associated morbidity
TEM is a safe and effective procedure for the treatment of selected early malignant rectal lesions and is associated with low morbidity. It is a therapeutic strategy based on a multidisciplinary team, careful patient selection, an audited surgical technique and a strict follow-up protocol

Summary

Introduction

The abdominal approach for the treatment of rectal tumors is associated with a considerable rate of morbidity. Conclusions: TEM is a safe and effective procedure for the treatment of selected early malignant rectal lesions and is associated with low morbidity It is a therapeutic strategy based on a multidisciplinary team, careful patient selection, an audited surgical technique and a strict follow-up protocol. Surgical treatment of rectal tumors has traditionally required an abdominal approach (open or laparoscopic), which includes the performance of sphincter-preservation interventions (low or ultra-low resection) or abdominoperineal resections; all depending on the location and infiltration of the lesion These radical interventions, in addition to sometimes requiring the creation of a stoma (permanent or temporary), are burdened with a not insubstantial mortality rate and a considerable frequency of complications such as genitourinary disorders, sexual dysfunction and abnormalities in defecation [1,2,3,4]. TEM—associated with low (4% - 24%) and, in most cases, irrelevant morbidity [10]—is a safe technique from both oncological and surgical points of view

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