What to Expect Before, During and After a Tem Procedures?

Theodore J Saclarides, MD, Maria C Mora Pinzon, MD, Amanda B Francescatti, BA

Loyola University Medical Center, Rush University Medical Center

Background: TEM is a minimally invasive technique used for the treatment of rectal tumors. The purpose of this study is to describe the procedure and its most common characteristic, including overall results.

Methods: Retrospective analysis of a prospectively collected database of all the patients that underwent TEM between 1990 – May 2012 for rectal tumors at Rush University Medical Center. The pathology reports were classified into: no residual, adenoma, carcinoma in situ (Tis) or invasive carcinoma.

Results: 444 patients were included in the study, mean age was 65.40 years (21 – 98). 260 (58.6%) were male. The average distance was 7 cm from the anal canal (range 0 – 16 cm). Average size of the tumor was 3.2 cm (range 2 – 10 cm). 72% of the patients had estimated blood loss (EBL) less than 25 cc, and the average time was 79.84 min (range 14 – 358); after a multivariate analysis, the factors that correlated with the duration of the procedure were EBL (t=11.244, p=0.000) and size of the specimen (t=7.228, p=0.000). Patients with invasive carcinoma were older (F=3.201 p=0.023), had more bleeding (F=3.342 p= 0.019), had smaller lesions (F=5.125 p=0.002), and the time required to complete the procedure was longer (F=8.094 p=0.000). Entry to the peritoneal cavity was seen in 8 patients (1.8%), no predictor factors for it were identified. The most common complaints were pain (20.9% of the cases), bleeding (23.1%), and fecal soiling in 20.1% of cases. 73 patients (16.4%) had recurrence of the tumor, adenomas had the higher recurrence rate (23%), followed by invasive carcinomas (19%) (p=NS). The recurrence rates by stage were: 16.4% for T1, 45.5% for T2-3 without additional treatment, 25% for T2-3 that received adjuvant therapy, and 10.5% for T2-3 that underwent radical surgery. Tumors size > 4 cm was associated with recurrence (X2=4.990 p= 0.025). The average time to recurrence was 25.76 months (range 1.6 – 182), no difference in time to recurrence based on pathology, size or age were identified. The average follow up time was 32.76 months (range 0 – 220).

Conclusion: Our study corroborates the safety of TEM, with a complication rate of 16.4%. Recurrence up to 20% was seen, mostly sharing the same pathologic entity as the index procedure; lesions higher than 4 cm have high risk of recurrence.
Key words: transanal endoscopic microsurgery, rectal tumor, local excision

Session: Poster Presentation

Program Number: P079

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