[Indications and results of transanal endoscopic microsurgery in the treatment of rectal tumours in a consecutive series of 52 patients]

Abstract

Introduction: The abdominal approach for the treatment of rectal tumours is associated with considerable morbidity. Transanal endoscopic microsurgery (TEM) is a technical alternative, and less invasive than radical surgery, and thus, with a lower associated morbidity. Also, with the correct selection of patients, TEM shows similar oncological results to radical surgery. The objective of this study is to review our results with TEM and discuss its indications in the treatment of rectal tumours.

Patients and method: An observational, retrospective study with prospective collection of data conducted from June 2008 to January 2011. TEM indications were: benign rectal tumours non-resectable using colonoscopy; early malignant rectal tumours (T(1)N(0)M(0)) with good prognostic factors: neoplastic tumours in more advanced stages in selected patients (high surgical risk, refused radical surgery or stoma and palliative care).

Results: A resection was performed using TEM on 52 patients (35 benign and 17 malignant tumours). The mean hospital stay was 4.9 days, with an associated morbidity of 15.3%. The R(0) resection in adenomas and carcinomas was 97.1% and 88.8% respectively. During a follow-up of 15 (3-31) months, one recurrence of an adenoma was observed which was re-operated on using TEM.

Conclusions: TEM is a safe and effective procedure for the treatment of benign and selected early malignant rectal tumours, and is associated with a low morbidity. However, it is a therapeutic strategy based on a multidisciplinary team, basically with careful selection of patients, a validated technique and a strict follow-up protocol.