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A Single Surgeon's Experience

Theodore J. Saclarides, MD

Arch Surg. 1998;133:595-599.

Objective  To evaluate a single surgeon's experience with transanal endoscopic microsurgery (TEM) with regard to incidence of complications, recurrence rate of benign and malignant lesions, and impact on the treatment of rectal cancer.

Design  Prospective tumor registry.

Setting  Tertiary care university hospital.

Patients  Seventy-three patients undergoing TEM between January 1991 and November 1996.

Main Outcome Measures  Complications, recurrence rates, and use of this technique with respect to radical operations.

Results  The arrival of TEM was associated with an increase in the number of operations for rectal cancer; however, the use of TEM remained constant relative to radical resections. Use of TEM resection alone is appropriate for all adenomas and cancers staged Tis and T1. Use of TEM alone is not an appropriate treatment for T2 cancers. Four patients (5%) experienced fecal soilage, which was long lasting in only 1 (1%).

Conclusions  Transanal endoscopic microsurgery is a safe technique and provides improved access to lesions in the middle and upper rectum. Thus far, it has not had a significant impact in the overall treatment of rectal cancer.

From the Section of Colon and Rectal Surgery, Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

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