Transanal Endoscopic Microsurgery for Benign and Malignant Rectal Tumors
Abstracts
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The purpose of this study was to evaluate morbidity and recurrence rate in patients treated with transanal endoscopic microsurgery (TEM) for rectal tumors. Material and Method. Seventy-nine patients, age 26-90 years, median 74 years, 45 men and 34 women were treated during the period March 1994 - November 2001. Indications for treatment were rectal adenomas in 72 patients and cancer in 7. There were 69 transmural excisions and 10 mucosal excisions. All patients were preoperatively staged with rectal ultrasound. The patients were treated using Wolf TEM equipment. Results. Operation time varied between 45 and 240 minutes, median 110 minutes. Distance from anal verge to lower border of the tumour were 2 - 18 cm, median 10 cm. Peroperative complications were rectal perforations in 2 patients treated by anterior resection and suture via celiotomy respectively. There was one death due to cardiac infarction. Other complications were pulmonary emboli (1) and hematoma in the suture line (1). Postoperative histological examination revealed 14 cancers; i.e. 7 patients with benign preoperative histology had cancer. Three of these patients were later operated with anterior resection (1) and abdominoperineal resection (2). Conclusion. Transanal endoscopic microsurgical excision of rectal tumours is a safe and precise technique well tolerated by high risk patients. A substantial number of patients with benign preoperative diagnoses have malignant disease indicating a need for improved preoperative diagnosis and staging. The method should be the primary choice for benign rectal tumours and in selected cases with early cancer. |
