title: Transanal endoscopic microsurgery (TEM) vs. radical surgery (RS) in the treatment of rectal cancer: indications, limitations, prospectives. A review.
abstract: OBJECTIVE
  Principal goal in the management of any patient with rectal cancer is to provide an optimal chance for cure while maintaining their quality of life. Transanal endoscopic microsurgery (TEM) is a minimal invasive procedure that allows full thickness local excision or rectal tumors. The role or TEM in the treatment of rectal cancer remains controversial. The aim of this study was to review the evidence related to the role of TEM compared to radical surgery in the treatment of rectal cancer.
  
  
  METHODS
  We reviewed 5 studies (two controlled randomized and three non-randomized) comparing outcome after TEM vs. radical surgery (RS), either open or laparoscopic, in patients with rectal cancer. We evaluated the results in terms of safety of the procedure as well as its efficacy.
  
  
  RESULTS
  Hospital stay, complication rate and overall morbidity and mortality were lower in the TEM groups in all studies. With the exception of one study, recurrence was slightly (but non-significantly) increased in the TEM groups. No difference for T2 tumors with TEM vs. laparoscopic resection was seen though. Overall survival was not statistically different.
  
  
  CONCLUSIONS
  TEM is a safe, effective minimal invasive method for treatment of T1 rectal carcinomas and possibly T2 carcinomas in selected patients after neoadjuvant chemoradiation. Its role in advanced tumor stages should be further defined.
authors.affiliation: Department of General-, Visceral-, Vascular- and Thoracic Surgery, Charitt, Campus Mitte, Humboldt University Berlin, Berlin, Germany. juergen.zieren@charite.de
authors.forename: J
authors.initials: J
authors.lastname: Zieren
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.forename: C
authors.initials: C
authors.lastname: Menenakos
mesh_terms: D006801:Humans; D008866:Microsurgery / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D011351:Proctoscopy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome