Transanal endoscopic microsurgery in the diagnosis and treatment of early rectal cancer

The clinical outcome of transanl endoscopic microsurgery (TEM) using Buess' operating rectoscope in the treatment of early rectal carcinomas is presented. Since 1992 we have performed TEM in 60 patients, of which 25 were early rectal cancer cases including 14 men and 11 women with avarage age of 60.8 (range; 35 to 90. Mean tumor size was 31.3mm(range; 10 to 85). Mean distance between the tumor and the anal verge was 10.5cm (range; 5 to 17). Mean operation time was 81.2 min. (range; 30 to 180). Mean specimen size was 46.7mm (range; 30 to 95). No significant complication was encountered during TEM. Postoperative complications accounted for small dehiscence(4%), stenosis(4%) and transient mild incontinence (8%). The stenosis case received successful endoscopic balloon dilation. Otherwise no treatment was required for the complications. Second operation was carried out in 3 cases as the pathological findings revealed either massive submucosal invasion in two cases or lymphduct infiltration in: one. Mean follow-up period was 1.8 years (range; 0.15 to 4.5). During this period local recurrence was seen in 1 case, who underwent rectal amputaion.TEM is a safe, minimally invasive therapy with low morbidity rate, providing an excellent ability of large en-bloc resection. TEM can be indicated not only as a radical intervention, but also for tumors with unknown infiltration grade to obtain definite patological diagnoses.