| Theme | Treatment of early rectal cancer -- Local excision vs. endoscopic resection | |
|---|---|---|
| Title | Clinical results of transanal endoscopic microsurgery (TEM) in treatment of early rectal cancer | |
| Publish Date | 2007/07 | |
| Author | Eiji Kanehira | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Akiko Umezawa | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Kazunori Kasama | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Tetsuya Kurosaki | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Takashi Oshiro | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Makoto Ishikawa | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| Author | Yoshimochi Kurokawa | Minimally Invasive Surgery Center, Yotsuya Medical Cube |
| [ Summary ] | The long term outcome of transanal endoscopic microsurgery (TEM) in the treatment of early rectal cancer is reported. The author has performed TEM in the original manner on 104 patients with early rectal carcinoma since 1992. In 96 cases, tumors were limited to the mucosa or very shallow submucosa, while in 4 cases, tumor invasion was detected in the middle of the submucosa. In the other 4 cases, there was massive submucosa invasion. The size of the tumors ranged from 10 to 140 mm with an average of 40.9 mm. The size of the specimens ranged from 25 to 150 mm with an average of 57.7 mm. En bloc resection was successfully performed in 100 cases (96 %) with the largest tumor measuring 14 cm in diameter. Operation time ranged from 25 to 300 minutes with an average of 91.7 minutes. 5 patients had to undergo re-operations because of positive margin, massive submucosal invasion or infiltration into the lymphducts. As a minor complication, 11 patients had temporary incontinence. One had stenosis, which was treated by endoscopic balloon dilatation. Over a 15 year period, 3 patients died due to recurrence. One had multiple liver metastasis, while the other two had local recurrence. TEM can be a viable option for local excision of early rectal cancer, when preoperative invasion depth diagnosis is accurate and the surgeon has sufficient skill. |
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