INTRODUCTION: Radical rectal resection is associated with significant morbidity and mortality. Given this, in the setting of premalignant and early malignancies of the rectum increasing attention has turned to the transanal endoscopic microsurgery (TEM) technique. In this series, we examine a single institution experience with this approach.
METHODS AND PROCEDURES: This is a retrospective analysis of a prospectively collected database of all TEM procedures performed at Indiana University Hospital between November 2007 and April 2009. All cases were included in this analysis regardless of indication.
RESULTS: There were 30 TEM procedures performed during this period. Mean age was 67 years (49 to 88). 77 percent of patients were male. Indications included adenoma (14), rectal adenocarcinoma (13), carcinoid (2), and melanoma (1). Rectal adenocarcinomas were staged uT1 (67%), uT2 (17%), and uT3 tumors (17%) based on pre-operative ultrasound. Pathologic staging was T1 (58%), T2 (17%), and T3 (25%). All uT3 tumors were approached with palliative intent. One understaged uT2 patient required subsequent low anterior resection. There were no 30 day deaths. Morbidity was 10%, including 1 urethral injury, 1 rectovaginal fistula, and 1 patient with urinary incontinence. Mean lesion diameter was 3 cm (0.8-6.9). Average distance from the anal verge was 6.9 cm (1-17). Average operative and total room times were 159 (105-231) and 206 minutes (129-259) respectively. Microscopic margins were positive in 2 patients. Mean blood loss was 30 ml (5-150). Average length of stay was 1.02 days (0.2-3).
CONSCLUSIONS: The TEM approach is associated with low blood loss and morbidity, and no mortality. It can often be performed as an outpatient or with minimal hospital stay. It is applicable for a range of rectal pathology, and for palliation in those patients not suitable for radical operation. Pre-operative staging is important for appropriate patient selection and was accurate with the exception of one patient in our series. TEM is a suitable alternative for lesions distant from the anal verge unresectable with conventional transanal approaches.
Program Number: P145