Local Treatment of Rectal Cancer (TEM Versus TAMIS Versus Transanal Excision)

  • John H. Marks
  • Harry Reynolds


Although total mesorectal excision (TME) and abdominoperineal resection (APR) are routinely employed for major oncologic resection of more advanced rectal lesions, the transanal approach to rectal cancer is uniquely poised to provide a curative option without the added morbidity of a transabdominal procedure. Additionally, a transanal option can help preserve function without compromising oncologic outcome. Since its first description in 1966, transanal excision continues to be an ideal option in select patients who present with early tumors and favorable characteristics, as well as a palliative procedure for more advanced disease in high-risk patients. In this chapter, we will describe the outcomes associated with various transanal excisional techniques, including transanal endoscopic microsurgery (TEM) and the more recently described transanal minimally invasive surgery (TAMIS) technique, to provide recommendations regarding options for managing these lesions.


Rectal Cancer Total Mesorectal Excision Local Excision Local Recurrence Rate Transanal Endoscopic Microsurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 14.1

Transanal endoscopic microsurgery (TEM) excision of a rectal mass (Video by Peter Cataldo, MD) (MOV 187521 kb)

Video 14.2

Transanal minimally invasive surgery removal of a rectal mass (Video by Matthew Albert, MD) (WMV 84531 kb)

Video 14.3

Transanal minimally invasive surgery removal of a rectal mass (Video by Matthew Albert, MD) (WMV 86612 kb)


  1. 1.
    Miles WE. A method of performing abdomino-perineal excision for carcinoma of the rectum and of the terminal portion of the pelvic colon. CA Cancer J Clin. 1908;21:361–4.CrossRefGoogle Scholar
  2. 2.
    Marks G, Mohiuddin M, Borenstein B. Preoperative radiation therapy and sphincter preservation by the combined abdominotranssacral technique in selected rectal cancers. Dis Colon Rectum. 1985;28(8):565.PubMedCrossRefGoogle Scholar
  3. 3.
    Buess G, Kipfmuller K, Hack D, et al. Technique of transanal endoscopic microsurgery. Surg Endosc. 1988;2(2):71–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Atallah S, Albert M, Larach S. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2010;24(9):2200–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Saclarides T. Transanal endoscopic microsurgery: a single surgeon’s experience. Arch Surg. 1998;133(6):595–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Dis Colon Rectum. 1995;38(12):1286–95.PubMedCrossRefGoogle Scholar
  7. 7.
    Wibe A, Syse A, Andersen E, et al. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum. 2004;47(1):48–58.PubMedCrossRefGoogle Scholar
  8. 8.
    Sitzler PJ, Seow-Choen F, Ho YH, et al. Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patients. Dis Colon Rectum. 1997;40:1472–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Brodsky JT, Richard GK, Cohen AM, et al. Variables correlated with the risk of lymph node metastasis in early rectal cancer. Cancer. 1992;69:322–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Killingback M. Local excision of carcinoma of the rectum: indications. World J Surg. 1992;16:437–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Blumberg D, Paty P, Guillem J, et al. All patients with small intramural rectal cancers are at risk for lymph node metastasis. Dis Colon Rectum. 1999;42:881–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Brown G, Radcliffe A, Newcombe R, et al. Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 2003;90:355–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Kim HJ, Wong WD. Role of endorectal ultrasound in the conservative management of rectal cancers. Semin Surg Oncol. 2000;19:358–66.PubMedCrossRefGoogle Scholar
  14. 14.
    Fidler IJ. Critical factors in the biology of human cancer metastasis: twenty-eighth G.H.A. Clowes memorial award lecture. Cancer Res. 1990;50:6130–8.PubMedGoogle Scholar
  15. 15.
    Bleday R, Breen E, Jessup JM, et al. Prospective evaluation of local excision for small rectal cancers. Dis Colon Rectum. 1997;40:388–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Steele GD, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol. 1999;6:433–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Mellgren A, Sirivongs P, Rothenberger A, et al. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43(8):1064–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Mellgren A, Goldberg J, Rothenberger D. Local excision – some reality testing. Surg Oncol Clin N Am. 2005;14(2):183–96.PubMedCrossRefGoogle Scholar
  19. 19.
    Madbouly K, Remzi F, Erkek B, et al. Recurrence after transanal excision of T1 rectal cancer: should we be concerned? Dis Colon Rectum. 2005;48(4):711–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Endreseth B, Myrvold H, Romundstad P, et al. Transanal excision vs. major surgery for T1 rectal cancer. Dis Colon Rectum. 2005;48(7):1380–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Saclarides T, Floyd N. Transanal endoscopic microsurgical resection of T1 rectal tumors. Dis Colon Rectum. 2006;42(2):165.Google Scholar
  22. 22.
    Moore JS, Cataldo PA, Osler T, Hyman NH. Transanal endoscopic microsurgery is more effective than traditional transanal excision for resection of rectal masses. Dis Colon Rectum. 2008;51:1026–30.PubMedCrossRefGoogle Scholar
  23. 23.
    Atallah S, Larach S, Albert M. Transanal minimally invasive surgery: a giant leap forward. Surg Endosc. 2009;24(9):2200–5.CrossRefGoogle Scholar
  24. 24.
    Albert MR, Atallah SB, deBeche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery (TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in the first 50 patients. Dis Colon Rectum. 2013;56(3):301–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Albert M, Atallah S, Larach S, deBeche-Adams T. Minimally invasive anorectal surgery: from Parks local excision to transanal endoscopic microsurgery to transanal minimally invasive surgery. Semin Colorectal Surg. 2013;24(1):42–9.CrossRefGoogle Scholar
  26. 26.
    Sebag-Montefiore D, Stephens R, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicenter, randomised trial. Lancet. 2009;373(9666):811–20.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Marks G, Mohiuddin M, Masoni L, et al. High-dose preoperative radiation and full-thickness local excision. Dis Colon Rectum. 1990;33(9):735–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Mohiuddin M, Marks G, Bannon J. High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancers. Int J Radiat Oncol. 1994;30(4):845–9.CrossRefGoogle Scholar
  29. 29.
    Annamaneni R, Marks J, Hamdan W, Curran T, Mohiuddin M, Marks G. Full thickness local excision of prospectively staged T2 rectal cancers after neoadjuvant radiation/chemoradiation. Poster presented at: Society of Surgical Oncology annual cancer symposium; Atlanta, GA: 2005.Google Scholar
  30. 30.
    Mizrahi B, Marks J, Marks G, et al. T2 rectal cancer: a comparison of radical surgery and local excision by transanal endoscopic microsurgery following neoadjuvant therapy. Poster presented at: American Society of Colon & Rectal Surgeons annual scientific meeting; Hollywood, FL: 2009.Google Scholar
  31. 31.
    Lezoche E, Guerrieri M, Paganini A, et al. Long-term results in patients with T2-3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg. 2005;92(12):1546–52.PubMedCrossRefGoogle Scholar
  32. 32.
    Doornebosch P, Ferenschild F, de Wilt J, et al. Treatment of recurrence after transanal endoscopic microsurgery (TEM) for T1 rectal cancer. Dis Colon Rectum. 2010;53(9):1234–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Tsai B, Finne C, Nordenstam J, et al. Transanal endoscopic microsurgery resection of rectal tumors: outcomes and recommendation. Dis Colon Rectum. 2010;53(1):16–23.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Colorectal Surgery, Department of SurgeryMain Line Health Systems, Lankenau Medical CenterWynnewoodUSA
  2. 2.Division of Colorectal SurgeryLankenau Medical CenterWynnewoodUSA
  3. 3.Colon and Rectal Cancer SurgeryCase Western Reserve University, University Hospitals Case Medical CenterClevelandUSA

Personalised recommendations