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Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors?

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Abstract

Background: In 1983 G. Buess, in Germany, developed transanal endoscopic microsurgery (TEM), a new minimally invasive technique for the treatment of rectal tumors.

Methods: Rectal lesions are excised through a modified rectoscope of 40 mm in diameter under stereoscopic control in the gas-dilated rectal cavity. Full-thickness excision, partialwall excision, or mucosectomy can be performed. Seventy-one patients were treated with the TEM technique in our department. Major complications were observed in one patient (1.4%). No mortality was reported.

Results: Histological examination revealed 40 (56.3%) villous adenomas, 6 (8.4%) pT1; 17 (23.9%) pT2; 5 (7%) pT3 carcinomas; and 3 (4.2%) other lesions. The recurrence rate was 2.8% for adenomas and 2.8% for carcinomas. The overall survival at mean follow-up of 17 months was 96.4%.

Conclusions: The advantages of TEM are less or no post-operative pain, unrestricted mobility, short hospitalization, quick rehabilitation, and absence of skin scars.

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References

  1. Auteri F, Alessandro L (1993) Cryotherapy as an alternative intervention to surgical excision in the management of cancer of the rectum. Clin Ter 142: 347–350

    Google Scholar 

  2. Bosset JF (1993) Determination of the optimal dose of 5-Fluorouracil when combined with low dose D,L-Leucovorin and irradiation in rectal cancer: results of three consecutive phase II studies. Eur J Cancer 29A: 1406–1410

    Google Scholar 

  3. Buess G, Kipfmuller K, Ibald R, Heintz A, Junginger T (1988) Clinical results of Transanal Endoscopic Microsurgery. Surg Endosc 2: 245–250

    Google Scholar 

  4. Buess G, Mentges B (1992) Transanal Endoscopic Microsurgery (T.E.M.). Minimally Invasive Therapy 1: 101–109

    Google Scholar 

  5. Coco C, Magistrelli P, Granone P (1992) Conservative surgery for early cancer of the distal rectum. Dis Colon Rectum 35: 131–136

    Google Scholar 

  6. Cunningham KN, Mills LR, Schuman BM, Mwakyusa DH (1994) Long-term prognosis of well-differentiated adenocarcinoma in endoscopically removed colorectal adenomas. Dig Dis Sci 39: 2034–2037

    Google Scholar 

  7. Eisenstat TE, Deck ST, Rubin RJ (1982) Five year survival in patients with carcinoma of the rectum treated by electrocoagulation. Am J Surg 143: 127–130

    Google Scholar 

  8. Frykholm GJ (1993) Preoperative or postoperative irradiation in adenocarcinoma of the rectum: final treatment results of a randomized trial and an evaluation of late secondary effects. Dis Colon Rectum 36: 564–572

    Google Scholar 

  9. Gall FP, Hermanek P (1988) Cancer of the rectum: local excision. Surg Clin North Am 68: 1353–1365

    Google Scholar 

  10. Graham RA, Garnsey L, Milburn Jessup J (1990) Local excision of rectal carcinoma. Am J Surg 160: 306–312

    Google Scholar 

  11. Hull TL, Lavery TC, Saxon JP (1994) Endocavitary irradiation. An option in select patients with rectal cancer. Dis Colon Rectum 37: 1266–1270

    Google Scholar 

  12. Lirici MM, Chiavellati L, Lezoche E, Martelli S, Melotti G, Morino M, Guerrieri M, Selmi I, Stipa S, Angelini L (1994) Transanal Endoscopic Microsurgery in Italy. End Surg 2: 255–258

    Google Scholar 

  13. Localio SA, Eng K, Coppa GF (1983) Abdomino-sacral resection for mid rectal cancer: a fifteen year experience. Ann Surg 198: 320–324

    Google Scholar 

  14. Mason AY (1970) Surgical access to the rectum: a trans-sphincteric exposure. Proc R Soc Med 63: 91–94

    Google Scholar 

  15. Minsky BD, Rich T, Recht A (1989) Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer. Cancer 63: 1421–1429

    Google Scholar 

  16. Mohiuddin M, Marks G (1987) High dose preoperative radiation and sphincter preservation in treatment of rectal cancer. Int J Radiat Oncol Biol Phys 13: 839–842

    Google Scholar 

  17. Mohuiddin M, Marks G, Bannon J (1994) High dose preoperative radiation and full-thickness local excision: a new option for selected T3 distal rectal cancer. Int J Radiat Oncol Biol Phys 30: 845–849

    Google Scholar 

  18. Papillon J (1990) Present status of radiation therapy in the conservative management of rectal cancer. Radiother Oncol 17: 275

    Google Scholar 

  19. Parks A (1968) A technique for excising extensive villous papillomas in the lower rectum. Proc R Soc Med 61: 441–442

    Google Scholar 

  20. Said S, Stippel D, Zieren J (1994) Minimal invasive surgery in the local treatment of rectal cancer. Ann Chir Gynaecol 83: 167–173

    Google Scholar 

  21. Shiessel R, Wunderlich M (1986) Transanal Excision und Anastomosentechink. Chirurg 57: 773–778

    Google Scholar 

  22. Steele G (1992) Local excision of early rectal cancer. Hepatogastroenterology 39: 212–214

    Google Scholar 

  23. Thompson WM, Halvorsen RA, Foster WL Jr (1986) Preoperative and postoperative CT staging of rectosigmoid carcinoma. Am J Roentgenol 146: 703

    Google Scholar 

  24. Willet CG, Compton CC, Shellito PC, Efird JT (1994) Selection factors for local excision or abdominalperineal resection of early stage rectal cancer. Cancer 73: 2716–2720

    Google Scholar 

  25. Wong WD, Orrom WJ, Jensen LL (1990) Preoperative staging of rectal cancer with endorectal ultrasonography. Perspectives in Colon and Rectal Surgery. Quality Medical Publishing, St Louis

    Google Scholar 

Download references

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Selected for the “Free papers session for EAES awards” at the Third International Congress on New Technology and Advanced Techniques in Surgery, Luxembourg, June 13–17, 1995

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Lezoche, E., Guerrieri, M., Paganini, A. et al. Is transanal endoscopic microsurgery (TEM) a valid treatment for rectal tumors?. Surg Endosc 10, 736–741 (1996). https://doi.org/10.1007/BF00193047

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  • DOI: https://doi.org/10.1007/BF00193047

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