Treatment of rectal adenoma and early rectal carcinoma by transanal endoscopic microsurgery

Abstract

Objective To investigate outcomes of transanal endoscopic microsurgery(TEM)for the treatment of rectal adenoma and early-stage rectal carcinoma. Methods Twenty-one patients with rectal tumors underwent TEM from June 2011 to June 2012.The operation was performed under general anesthesia.The patients were placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO2 insufflation to keep the rectum open.Under the stereoscope and laparoscopic-type instruments, the tumor was completely resected(submucosal or full-thickness excision)using a needle diathermy or a 5-mm ultrasonic dissector.The operative wound was closed with intra-lumen continuous sutures. Results The rectal tumor was completely removed with negative resection margins in all the 21 patients.The operating time was 45~160 min(mean, 90 min)and the intraoperative blood loss was 0~60 ml(mean, 15 ml). Complications included fever in 5 patients, acute retention of urine in 1 patient, and secondary hemorrhage following Aspirin taking in 2 patients.The postoperative pathological stages were T0 in 11 patients, Tis in 5 patients, T1 in 3, and T2 in 2.Follow-up checkups in the 21 patients until now revealed no local recurrence and distant metastasis. Conclusions TEM is a safe and effective minimally invasive surgical technique for the treatment of rectal adenoma and early rectal carcinoma. Key words: Rectal neoplasms; Surgical procedures, minimally invasive; Early diagnosis; Adenoma