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Surgical Treatment

Doornebosch PG, Ferenschild FT, de Wilt JH et al.

IJsselland Hospital, Capelle aan den IJssel, The Netherlands.

 Dis Colon Rectum 2010;53:1234–9.

Editor’s note: Transanal endoscopic microsurgery (TEM) is an invasive surgical procedure designed for the local resection of rectal lesions. The advantages of this technique include reduced morbidity and mortality rates, reduced long-term dysfunction, and reduced need for temporary or definitive colostomy. TEM is indicated for the removal of rectal adenomas or T1 adenocarcinomas with favorable histological findings (e.g. no lymphovascular invasion and a good or moderate degree of differentiation). The indications for TEM in other malignant tumors (e.g. carcinoids and gastrointestinal stromal tumors) are still uncertain. TEM is an option in high-risk surgical patients and in those unwilling to undergo radical surgery. The authors of a recent large published series reported post-TEM local recurrence rates of 9.8% for T1 adenocarcinomas, 23.5% for T2 adenocarcinomas, 100% for T3 adenocarcinomas, and 0% for carcinoid tumors (Dis Colon Rectum 2010;53:16–23). Other authors have reported 5-year survival rates of up to 100% in patients with tumor in situ (Tis) or T1 lesions and 70% in those with T2 lesions after TEM (Surg Endosc 2006;20:541–5).

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