Local surgical treatment of rectal cancer.

Local surgical treatment of rectal cancer as a curative procedure is only indicated in early rectal cancers. Our indication is T1 low risk cancer according to Hermanek. Conventional transanal procedures are limited to tumours located in the lower rectum and the precision of the excision is restricted by the limitation of the surgeon's visualisation during the procedure. Dorsal approaches show a high rate of complications and should no longer be performed. Transanal endoscopic microsurgery is a technique which has been in clinical use since 1983. By the use of complex technology, precise surgical dissection under a magnified stereoscopic view is possible. With the use of up to three instruments and new instrument technologies, full thickness excision up to segmental resection is possible. The resulting defect is routinely closed at the end of the procedure by a continuous endoscopic suture. The latest results based on 265 tumour resections at the University of Tübingen and 1900 operations based on a German review show positive results. The recurrence rate as a sign of precision of procedure is low and the postoperative complication rate is lower than with conventional procedures.