Transanal Endoscopic Microsurgery: Where it Stands as of Today?

Abstract

Objective: To review the present role of transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms. Methods: Literature search was conducted with restriction to english language and only published material was considered. Search was performed at Medline, Google, Cochrane library and SpringerLink. Search terms were: transanal endoscopic microsurgery, TEM, rectal cancer, rectal adenoma and carcinoid tumor. Results and conclusion: The review of the present literature is confirming the increasing acceptance of TEM, as a primary modality, over conventional surgery in the management of early rectal cancers, especially pT1 lesions. As far as pT2 is considered, it has to be combined with either adjuvant chemoradiation or salvage surgery. For locally advanced pT3, lesions, it is not preferred unless neoadjuvant therapy is successful in downstaging the tumor or in patients who refuse or are unfit for major surgery. However, the cost of equipment and steep learning curve are restricting this therapy to few specialized centers around the world.