Transanal endoscopic microsurgery.

Transanal endoscopic microsurgery (TEM) is a minimally invasive surgical technique that was developed more than two decades ago to manage distal colorectal neoplasias. The aim of the current study was to present a prospective review of 7 years of experience in using this equipment. All patients undergoing TEM between 1999 and 2007 were prospectively evaluated. Patients underwent regular endoscopic follow up. Cumulative incidence probability analysis was used to calculate rates of recurrence. The study involved 232 patients, median age 68 years (interquartile range (IQR), 37-90). The median neoplasia area was 12 cm(2) (IQR, 6-25 cm(2)) and the median height above the anal verge was 9 cm (IQR, 3-17 cm). Histology indicated 128 adenomas, 52 carcinomas in situ, and 52 adenocarcinomas. The median postoperative stay was 1 day (IQR, 1-3 days). There was one (0.5%) unplanned return to theatre and no postoperative deaths. Sixteen patients (6.9%) underwent more radical surgical procedures following the identification of carcinoma in the resected specimen. During a median follow up of 4.2 years (IQR, 2.6-6.2 years), the 5-year cumulative incidence for local recurrence for benign pathology was 3.1% (95% confidence interval (CI): 1.2-6.7%, n = 180) and for cancers managed primarily by TEM excision it was 8.5% (95%CI: 1.4-23.9%, n = 36). TEM is an excellent treatment modality for benign rectal neoplasias of any size, and in any location. TEM is an oncologically inferior treatment for rectal cancer, however, when compared to more radical treatments. Its principal advantage in this setting is that it is associated with relatively minimal morbidity and mortality.