Abstract
Purpose
Transanal endoscopic microsurgery, developed by Buess in the 1980s, has become increasingly popular in recent years. No large studies have compared the effectiveness of transanal endoscopic microsurgery with traditional transanal excision.
Methods
Between 1990 and 2005, 171 patients underwent traditional transanal excision (n = 89) or transanal endoscopic microsurgery (n = 82) for rectal neoplasms. Medical records were reviewed to determine type of surgery, resection margins, specimen fragmentation, complications, recurrence, lesion type, stage, and size.
Results
The groups were similar with respect to age, sex, lesion type, stage, and size. Mean follow-up was 37 months. There was no difference in the complication rate between the groups (transanal endoscopic microsurgery 15 percent vs. traditional transanal excision 17 percent, P = 0.69). Transanal endoscopic microsurgery was more likely to yield clear margins (90 vs. 71 percent, P = 0.001) and a nonfragmented specimen (94 vs. 65 percent, P < 0.001) compared with transanal excision. Recurrence was less frequent after transanal endoscopic microsurgery than after traditional transanal excision (5 vs. 27 percent, P = 0.004).
Conclusions
Transanal endoscopic microsurgery is the technique of choice for local excision of rectal neoplasms.
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References
Balch GC, De Meo A, Guillem JG. Modern management of rectal cancer: a 2006 update. World J Gastroenterol 2006;12:3186–95.
Bentrem DJ, Okabe S, Wong WD, et al. T1 adenocarcinoma of the rectum: transanal excision or radical surgery? Ann Surg 2005;242:472–9.
Bretagnol F, Rullier E, George B, et al. Local therapy for rectal cancer: still controversial? Dis Colon Rectum 2007;50:523–33.
Fucini C, Segre D, Trompetto M. Local excision of rectal polyp: indications and techniques. Tech Coloproctol 2004;8(Suppl 2):s300–4.
Gonzalez QH, Heslin MJ, Shore G, et al. Results of long-term follow-up for transanal excision for rectal cancer. Am Surg 2003;69:675–8.
Pigot F, Bouchard D, Mortaji M, et al. Local excision of large rectal villous adenomas: long-term results. Dis Colon Rectum 2003;46:1345–50.
Sengupta S, Tjandra JJ. Local excision of rectal cancer: what is the evidence? Dis Colon Rectum 2001;44:1345–61.
Buess G, Hutterer F, Theiss J, et al. A system for a transanal endoscopic rectum operation [in German]. Chirurg 1984;55:677–80.
Saclarides TJ. Transanal endoscopic microsurgery: a single surgeon’s experience. Arch Surg 1998;133:595–9.
Cataldo PA. Transanal endoscopic microsurgery. Surg Clin North Am 2006;86:915–25.
Middleton PF, Sutherland LM, Maddern GJ. Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 2005;48:270–84.
Demartines N, von Flue MO, Harder FH. Transanal endoscopic microsurgical excision of rectal tumors: indications and results. World J Surg 2001;25:870–5.
Healey MA, Shackford SR, Osler TM, et al. Complications in surgical patients. Arch Surg 2002;137:611–8.
Hosmer DL. Applied survival analyses. New York: Wiley and Sons, 1999.
Guerrieri M, Baldarelli M, Morino M, et al. Transanal endoscopic microsurgery in rectal adenomas: experience of six Italian centres. Dig Liver Dis 2006;38:202–7.
Dixon MR, Finne CO, Madoff RD, et al. Transanal endoscopic microsurgery (TEM) improves outcome in local treatment of early rectal cancer. Dis Colon Rectum 2006;49:715–6.
Keck JO, Schoetz DJ Jr, Roberts PL, et al. Rectal mucosectomy in the treatment of giant rectal villous tumors. Dis Colon Rectum 1995;38:233–8.
Sakamoto GD, MacKeigan JM, Senagore AJ. Transanal excision of large, rectal villous adenomas. Dis Colon Rectum 1991;34:880–5.
Langer C, Liersch T, Suss M, et al. Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 2003;18:222–9.
Morschel M, Heintz A, Bussmann M, Junginger T. Follow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps. Langenbecks Arch Surg 1998;383:320–4.
Salm R, Lampe H, Bustos A, Matern U. Experience with TEM in Germany. Endosc Surg Allied Technol 1994;2:251–4.
Winde G, Schmid KW, Reers B, Bunte H. Microsurgery in prospective comparison with conventional transanal excision or anterior rectum resection in adenomas and superficial carcinomas [in German]. Langenbecks Arch Chir Suppl Kongressbd 1996;113:265–8.
Floyd ND, Saclarides TJ. Transanal endoscopic microsurgical resection of pT1 rectal tumors. Dis Colon Rectum 2006;49:164–8.
Maslekar S, Pillinger SH, Monson JR. Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 2007;21:97–102.
Winde G, Nottberg H, Keller R, et al. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum 1996;39:969–76.
Stipa F, Burza A, Lucandri G, et al. Outcomes for early rectal cancer managed with transanal endoscopic microsurgery: a 5-year follow-up study. Surg Endosc 2006;20:541–5.
Mahmoud N, Madoff R, Rothenberger D, Finne C. Transanal endoscopic microsurgery (TEM) reduces the incidence of positive margins compared with transanal excision for rectal tumors. Dis Colon Rectum 2001;44:A30.
McCloud JM, Waymont N, Pahwa N, et al. Factors predicting early recurrence after transanal endoscopic microsurgery excision for rectal adenoma. Colorectal Dis 2006;8:581–5.
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Dr. Cataldo is an instructor and an invited speaker for Richard Wolf Medical Instruments Company.
Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.
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Moore, J.S., Cataldo, P.A., Osler, T. et al. Transanal Endoscopic Microsurgery is more Effective than Traditional Transanal Excision for Resection of Rectal Masses. Dis Colon Rectum 51, 1026–1031 (2008). https://doi.org/10.1007/s10350-008-9337-x
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DOI: https://doi.org/10.1007/s10350-008-9337-x