Skip to main content

Advertisement

Log in

Transanal endoscopic microsurgery for rectal tumors: experience at Korea’s National Cancer Center

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to transanal excision, enabling complete local excision of selected benign or malignant rectal tumors. This study aimed to determine the surgical and oncologic results for rectal tumors excised by TEM.

Methods

From November 2001 to October 2007, 45 patients underwent TEM for excision of adenoma (13 patients), carcinoid tumor (6 patients), and carcinoma (26 patients). The patients included 27 men and 18 women with a median age of 52 years (range, 22–72 years).

Results

The median tumor distance from the anal verge was 7 cm (range, 3–15 cm), and the median tumor size was 17 mm (range, 2–60 mm). There was no procedure-related morbidity or mortality. However, one patient with rectal carcinoma died of lung cancer during the follow-up period. Of 13 patients with adenomas, 1 patient (7.7%, 1/13) experienced local recurrence 5 months after surgery. No recurrence occurred for six patients with carcinoid tumors. Histologic examination of the carcinomas showed pathologic tumor (pT) stage 0 (ypT0) in 2 patients, pT1 in 17 patients (including ypT1 in 1 patient), pT2 in 6 patients, and pT3 in 1 patient. Immediate salvage surgery was performed for five patients (19%, 5/26). During a median follow-up period of 37 months (range, 5–72 months), one patient (3.8%, 1/26) experienced local recurrence. The overall and disease-free 5-year survival rates for patients with carcinoma were 96.2% and 88.5%, respectively.

Conclusions

The TEM procedure is a safe and appropriate surgical treatment option for benign rectal tumors. With strict patient selection, it is oncologically safe for early-stage rectal carcinomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buess G, Hutterer F, Theiss J, Bobel M, Isselhard W, Pichlmaier H (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680

    CAS  PubMed  Google Scholar 

  2. Sakamoto GD, MacKeigan JM, Senagore AJ (1991) Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 34:880–885

    Article  CAS  PubMed  Google Scholar 

  3. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43:1064–1071, discussion 1064–1071

    Google Scholar 

  4. Moore JS, Cataldo PA, Osler T, Hyman NH (2008) Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum 51:1026–1030, discussion 1021–1030

    Google Scholar 

  5. Lee W, Lee D, Choi S, Chun H (2003) Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc 17:1283–1287

    Article  CAS  PubMed  Google Scholar 

  6. Palma P, Freudenberg S, Samel S, Post S (2004) Transanal endoscopic microsurgery: indications and results after 100 cases. Colorectal Dis 6:350–355

    Article  CAS  PubMed  Google Scholar 

  7. Mentges B, Buess G, Schafer D, Manncke K, Becker HD (1996) Local therapy of rectal tumors. Dis Colon Rectum 39:886–892

    Article  CAS  PubMed  Google Scholar 

  8. Steele RJ, Hershman MJ, Mortensen NJ, Armitage NC, Scholefield JH (1996) Transanal endoscopic microsurgery: initial experience from three centres in the United Kingdom. Br J Surg 83:207–210

    Article  CAS  PubMed  Google Scholar 

  9. Saclarides TJ (1998) Transanal endoscopic microsurgery: a single surgeon’s experience. Arch Surg 133:595–598, discussion 598–599

    Google Scholar 

  10. Neary P, Makin GB, White TJ, White E, Hartley J, MacDonald A, Lee PW, Monson JR (2003) Transanal endoscopic microsurgery: a viable operative alternative in selected patients with rectal lesions. Ann Surg Oncol 10:1106–1111

    Article  CAS  PubMed  Google Scholar 

  11. Stipa F, Lucandri G, Ferri M, Casula G, Ziparo V (2004) Local excision of rectal cancer with transanal endoscopic microsurgery (TEM). Anticancer Res 24:1167–1172

    PubMed  Google Scholar 

  12. Ganai S, Kanumuri P, Rao RS, Alexander AI (2006) Local recurrence after transanal endoscopic microsurgery for rectal polyps and early cancers. Ann Surg Oncol 13:547–556

    Article  PubMed  Google Scholar 

  13. Bretagnol F, Merrie A, George B, Warren BF, Mortensen NJ (2007) Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg 94:627–633

    Article  CAS  PubMed  Google Scholar 

  14. Zacharakis E, Freilich S, Rekhraj S, Athanasiou T, Paraskeva P, Ziprin P, Darzi A (2007) Transanal endoscopic microsurgery for rectal tumors: the St. Mary’s experience. Am J Surg 194:694–698

    Article  PubMed  Google Scholar 

  15. Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284

    Article  PubMed  Google Scholar 

  16. McCloud JM, Waymont N, Pahwa N, Varghese P, Richards C, Jameson JS, Scott AN (2006) Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorectal Dis 8:581–585

    Article  CAS  PubMed  Google Scholar 

  17. Kinoshita T, Kanehira E, Omura K, Tomori T, Yamada H (2007) Transanal endoscopic microsurgery in the treatment of rectal carcinoid tumor. Surg Endosc 21:970–974

    Article  CAS  PubMed  Google Scholar 

  18. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H (1996) Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 39:969–976

    Article  CAS  PubMed  Google Scholar 

  19. Killingback M (1992) Local excision of carcinoma of the rectum: indications. World J Surg 16:437–446

    Article  CAS  PubMed  Google Scholar 

  20. Maslekar S, Pillinger SH, Monson JR (2007) Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 21:97–102

    Article  CAS  PubMed  Google Scholar 

  21. Minsky BD, Enker WE, Cohen AM, Lauwers G (1994) Local excision and postoperative radiation therapy for rectal cancer. Am J Clin Oncol 17:411–416

    Article  CAS  PubMed  Google Scholar 

  22. Willett CG, Tepper JE, Donnelly S, Wood WC, Shellito PC, Rodkey GV, Stracher MA, Compton CC (1989) Patterns of failure following local excision and local excision and postoperative radiation therapy for invasive rectal adenocarcinoma. J Clin Oncol 7:1003–1008

    CAS  PubMed  Google Scholar 

  23. Kim CJ, Yeatman TJ, Coppola D, Trotti A, Williams B, Barthel JS, Dinwoodie W, Karl RC, Marcet J (2001) Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 234:352–358, discussion 358–359

    Google Scholar 

  24. Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G (2005) Long-term results in patients with T2–3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 92:1546–1552

    Article  CAS  PubMed  Google Scholar 

  25. Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK (1998) Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133:894–899

    Article  CAS  PubMed  Google Scholar 

  26. Poulin EC, Schlachta CM, Gregoire R, Seshadri P, Cadeddu MO, Mamazza J (2002) Local recurrence and survival after laparoscopic mesorectal resection for rectal adenocarcinoma. Surg Endosc 16:989–995

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Seung-Yong Jeong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jeong, W.K., Park, J.W., Choi, H.S. et al. Transanal endoscopic microsurgery for rectal tumors: experience at Korea’s National Cancer Center. Surg Endosc 23, 2575–2579 (2009). https://doi.org/10.1007/s00464-009-0466-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0466-7

Keywords

Navigation