International Journal of Colorectal Disease

, Volume 22, Issue 11, pp 1347–1352 | Cite as

Rectal adenocarcinoma and transanal endoscopic microsurgery. Diagnostic challenges, indications and short term results in 142 consecutive patients

  • G. Baatrup
  • H. Elbrønd
  • P. Hesselfeldt
  • P. Wille-Jørgensen
  • P. Møller
  • B. Breum
  • N. Qvist
Original Article

Abstract

Purpose

The objective of this study was to present short-term results of transanal endoscopic microsurgery (TEM) of rectal adenocarcinomas registered in a national database.

Methods

A Danish TEM group was established in 1995. The group organized a database for prospective and consecutive registration of all TEM procedures. The perioperative course of all rectal cancers treated with TEM and registered in this database is analysed.

Results

One hundred forty-two patients had TEM for rectal cancer. In 43%of the patients, the cancer diagnosis was not recognized before TEM. Eighty-five percent of all tumors were classified as benign based on macroscopic appearance; on digital rectal examination, 35% were benign, rectal ultrasound classified 15% as benign, and the preoperative biopsy was benign in 36%. Forty-three cancers (29%) were classified as low risk cancers. High ages were an indication for TEM in 22% and concurrent disease in 21%. Minor complications were encountered in 39 cases, major complications in 4 cases, and 1 patient died within 30 days.

Conclusion

All larger rectal tumors should be evaluated for malignancy before treatment, even if TEM is the only surgical option, due to high age and comorbidiy. Rectal ultrasound appears to produce the fewest false negative results, but it should be combined with biopsies and clinical evaluation. Multiple biopsies may be beneficial in the case of larger adenomas. When resecting large sessile tumors, there is a considerable risk of incomplete radicality. The short term mortality and morbidity of TEM is low even in old patients with comorbidiy.

Keywords

TEM Transanal endoscopic microsurgery Cancer Adenocarcinoma 

Notes

Acknowledgements

Stein Magne Låstad, Anita Anfindsen and Ann Marie Jøgensen are gratefully acknowledged for construction of the Access database and data management. The study was financed by “The General Medical Research Foundation, University of Bergen”.

Conflict of interest statement

None.

References

  1. 1.
    Harling H, Bülow S, Kronborg O et al (2003) Survival of rectal cancer in patients in Denmark during 1994–99. Colorectal Dis 6:153–157CrossRefGoogle Scholar
  2. 2.
    Tekkis PP, Poloniecki JD, Thompson MR et al (2003) Operative mortality in colorectal cancer: Prospective nationalstudy. BMJ 22:1196–1201CrossRefGoogle Scholar
  3. 3.
    Buess G, Hutterer F, Theiss J et al (1984) A system for a transanal endoscopic rectum operation. Chirurg 55:677–680PubMedGoogle Scholar
  4. 4.
    Røkke O, Iversen KB, Øvrebø K et al (2005) Local resection of rectal tumors by transanal endoscopic microsurgery: Experience with the first 70 cases. Dig Surg 22:182–190CrossRefPubMedGoogle Scholar
  5. 5.
    Cook TA, Mortensen NJMcC (2000) Local methods of treatment of rectal cancer. Colorectal Dis 2:252–263CrossRefPubMedGoogle Scholar
  6. 6.
    Endreseth BH, Myrvold HE, Romundstad P et al (2005) Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum 48:1380–1388CrossRefPubMedGoogle Scholar
  7. 7.
    Bemelman WA (2005) Minimally invasive surgery for early lower GI cancer. Best Prac Res Clin Gastroenterol 19:993–1005CrossRefGoogle Scholar
  8. 8.
    de Graaf EJ (2003) Transanal endoscopic microsurgery. Scand J Gastroenterol Suppl 239:34–39CrossRefGoogle Scholar
  9. 9.
    Nascimbeni R, Burgart LJ, Nivatvongs S (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45:200–206CrossRefPubMedGoogle Scholar
  10. 10.
    Bülow S, Christensen IJ, Harling H (2003) Recurrence and survival after mesorectal excision for rectal cancer.. Br J Surg 8:974–980CrossRefGoogle Scholar
  11. 11.
    Lloyd GM, Sutton CD, Marshall LJ et al (2002) Transanal endoscopic microsurgery—lessons form a single UK centre series. Colorectal Dis 4:467–472CrossRefPubMedGoogle Scholar
  12. 12.
    Balslev I, Pedersen M, Teglbjaerg PS et al (1986) Major or local surgery for cure in early rectal and sigmoid carcinoma—a prospective evaluation. Eur J Surg Oncol 12:373–377PubMedGoogle Scholar
  13. 13.
    Morson BC, Whiteway JE, Jones EA (1984) Histopathology and prognosis of malignant colorectal polyps treated by endoscopic polypectomy. Gut 25:437–444CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Low RN, McCue M, Barone C et al (2003) MR staging of primary colorectal carcinoma: comparison with surgical and histopathological findings. Abdom Imaging 28:784–793CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • G. Baatrup
    • 1
    • 2
  • H. Elbrønd
    • 3
  • P. Hesselfeldt
    • 4
  • P. Wille-Jørgensen
    • 5
  • P. Møller
    • 5
  • B. Breum
    • 4
  • N. Qvist
    • 6
  1. 1.Section for Colorectal Surgery, Department of SurgeryHaukeland University HospitalBergenNorway
  2. 2.Section for Surgery, Department of Surgical SciencesUniversity of BergenBergenNorway
  3. 3.Department of SurgeryÅlborg HospitalÅlborgDenmark
  4. 4.Department of SurgeryHvidovre University HospitalCopenhagenDenmark
  5. 5.Department of Surgery KBispebjerg University HospitalCopenhagenDenmark
  6. 6.Department of SurgeryOdense University HospitalOdenseDenmark

Personalised recommendations