Laparoscopy
Transanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience

https://doi.org/10.1016/j.amjsurg.2007.03.005Get rights and content

Abstract

Background

The aim of this study is to describe a single institution’s experience in the use of transanal endoscopic microsurgery for rectal tumors.

Methods

Between 1996 and 2005, transanal endoscopic microsurgery was performed in 76 patients. The histologic diagnosis was adenoma in 48 and adenocarcinoma in 28 patients.

Results

Clear resection margins were achieved in 71 of 74 patients (95.9%). Overall morbidity was 18.9% because 14 patients developed minor (10 patients) or major complications (4 patients). During the follow-up, benign tumor recurrence was detected in 3 patients (6.3%). The recurrence rates among patients with T1, T2, and T3 malignant tumors were 7.1%, 42.8%, and 66.6%, respectively.

Comments

Transanal endoscopic microsurgery is a safe and feasible technique with low incomplete excision rates and may be the preferred method in patients with benign rectal tumors. Its role in the management of malignant tumors should be limited to selected patients with T1 lesions.

Section snippets

Materials and Methods

Patients undergoing TEMS between 1996 and 2005 at St Mary’s Hospital in London were identified from a prospective colorectal database. During this time period, TEMS was performed in 76 patients with rectal tumors. The mean age of the patients was 66.3 (37 to 91) years. The male-to-female ratio was 48:28.

All patients underwent preoperative endoscopic biopsy and radiologic staging by magnetic resonance imaging and/or endoscopic ultrasound. The preoperative histologic diagnosis was benign adenoma

Results

Mean operating time was 80.6 (38–180) minutes, and the mean hospital stay was 3.2 (1 to 51) days. Mortality among the patients in our study was 0%. Overall morbidity was 18.4% because 14 patients developed minor or major complications (4 patients or 5.2%). Three patients had perioperative complications, ie, perforation of the intraperitoneal rectum, and the defect could not be closed primarily by way of the TEMS rectoscope. Two of these patients were treated by conversion to anterior resection

Comments

TEMS is a minimally invasive sphincter-preserving procedure that currently plays an expanding role in the surgical management of rectal tumors. When colonoscopic polypectomy fails to remove large and sessile adenomas because of technical reasons, surgical options include either local resection or major operations, such as low anterior and abdominoperineal resection [1]. The most important factor in avoiding local recurrence after local excision of a rectal adenoma is the complete removal of the

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