Transanal endoscopic microsurgery: A single centre experience

Introduction: The aim of this study was to evaluate the implementation of transanal endoscopic microsurgery (TEM) technique for the removal of rectal adenomas or early rectal cancer in the Centre of Oncosurgery, Oncology Institute of Vilnius University.

Methods: From October 2009 to June 2011 a total of 41 patients underwent TEM for rectal adenomas or early rectal cancer. 19 were women and 22 men, median age was 64 years, range 31 to 87 years. Rectal lesions were from 0 9 to 7 0 cm in diameter, and 3 to 13 cm from the anal verge. Full thickness excision with one cm safety margins was attempted in all cases, followed by closing of the rectal wall defect in one-layer using a running monocryl 3.0 suture using silver clips. In one case (TEM for T2 rectal cancer), the abdominal cavity was penetrated and two-layer closure was performed.

Results: In these series of 41 patients there were no complications or deaths. Hospital stay ranged from 2 to 13 days, average 6 days. Final histology revealed 24 (59%) lesions to be tubular or villous adenomas, in 6 (15%) foci of carcinoma in situ (pTis) were present. Five (12%) were TNM stagepT1 and 4 (10%) werepT2 cancers. Well-differentiated neuroendocrine tumors were found in 2 (4%). A 60 year old woman underwent open partial TME in the pT1 group; her tumor was in upper third of the rectum and preoperatively judged as pTis. In another case (pT1 group) in an 81 year old man, lymphovascular invasion was present on final pathology. He received postoperative adjuvant chemoradiotherapy. All patients are under surveillance.

Conclusion: TEM is safe and is an alternative to transanal excision for rectal adenomas and early rectal cancer. Further follow-up is necessary to evaluate recurrence rates and oncological results in a subgroup of patients with invasive rectal cancer.

Key words: Rectal polyp; Rectal cancer; Transanal endoscopic microsurgery (TEM)

DOI: http://dx.doi.org/10.4038/sljs.v29i1.3577

Sri Lanka Journal of Surgery 2011: 29(1) 19-22