E J R de Graaf1. 1. Dept. of Surgery, IJsselland Hospital, Capelle aan den Ijssel, The Netherlands. EdGraaf@ysl.nl
Abstract
BACKGROUND: Transanal endoscopic microsurgery (TEM) is a newly developed, minimally invasive technique for the local resection of rectal tumours. Its place needs to be defined. METHODS: Literature review. RESULTS: Local excision of rectal tumours is associated with low mortality and morbidity. It is indicated in adenomas for curation and in rectal cancer for palliation. Transanal resection is used most frequently, but its use is limited. Other local techniques have no added value and are used sparingly. TEM is a newly developed, minimally invasive technique. Its technical characteristics allow an excellent view also in larger and more proximal tumours. Compared to other local techniques, mortality and morbidity are minimal and a laparotomy is more often preventable. Proper histological examination is possible and free margins are almost always observed. In adenomas it results in hardly any recurrences and in rectal cancer it can be adequately used for palliation. The results following local resection for rectal cancer with curative intent are promising, but they are only described anecdotally. CONCLUSIONS: TEM is an elegant technique with excellent results. It imposes itself as a method of choice for the local resection of rectal adenomas and of rectal cancer for palliation. If curation is intended in rectal carcinomas, TEM should be exercised with caution. Proper judgement over existing local techniques and TEM is being impeded by a lack of scientific argumentation.
BACKGROUND: Transanal endoscopic microsurgery (TEM) is a newly developed, minimally invasive technique for the local resection of rectal tumours. Its place needs to be defined. METHODS: Literature review. RESULTS: Local excision of rectal tumours is associated with low mortality and morbidity. It is indicated in adenomas for curation and in rectal cancer for palliation. Transanal resection is used most frequently, but its use is limited. Other local techniques have no added value and are used sparingly. TEM is a newly developed, minimally invasive technique. Its technical characteristics allow an excellent view also in larger and more proximal tumours. Compared to other local techniques, mortality and morbidity are minimal and a laparotomy is more often preventable. Proper histological examination is possible and free margins are almost always observed. In adenomas it results in hardly any recurrences and in rectal cancer it can be adequately used for palliation. The results following local resection for rectal cancer with curative intent are promising, but they are only described anecdotally. CONCLUSIONS: TEM is an elegant technique with excellent results. It imposes itself as a method of choice for the local resection of rectal adenomas and of rectal cancer for palliation. If curation is intended in rectal carcinomas, TEM should be exercised with caution. Proper judgement over existing local techniques and TEM is being impeded by a lack of scientific argumentation.
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Authors: Frank J C van den Broek; Eelco J R de Graaf; Marcel G W Dijkgraaf; Johannes B Reitsma; Jelle Haringsma; Robin Timmer; Bas L A M Weusten; Michael F Gerhards; Esther C J Consten; Matthijs P Schwartz; Maarten J Boom; Erik J Derksen; A Bart Bijnen; Paul H P Davids; Christiaan Hoff; Hendrik M van Dullemen; G Dimitri N Heine; Klaas van der Linde; Jeroen M Jansen; Rosalie C H Mallant-Hent; Ronald Breumelhof; Han Geldof; James C H Hardwick; Pascal G Doornebosch; Annekatrien C T M Depla; Miranda F Ernst; Ivo P van Munster; Ignace H J T de Hingh; Erik J Schoon; Willem A Bemelman; Paul Fockens; Evelien Dekker Journal: BMC Surg Date: 2009-03-13 Impact factor: 2.102