title: Transanal endoscopic microsurgery: indications, results and controversies.
abstract: Transanal endoscopic microsurgery (TEM) was introduced in 1983 as a minimally invasive technique allowing the resection of adenomas and early rectal carcinomas unsuitable for local or colonoscopic excision which would otherwise require major surgery. After 25 years, there is still much debate about the procedure. This article presents the TEM technique, indications, results and complications, focusing on its role in rectal cancer. The controversial points addressed include long-term results, TEM in high-risk T1 lesions, TEM associated with combined modality therapy (CMT) for invasive rectal cancer and salvage therapy after TEM. The future perspectives for TEM are promising and its association with CMT will probably expand the select group of patients who will benefit from the procedure.
authors.affiliation: Department of Gastroenterology, Division of Colorectal Surgery, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Andre Roncon
authors.initials: AR
authors.lastname: Dias
authors.forename: Caio Sergio Rizkallah
authors.initials: CS
authors.lastname: Nahas
authors.forename: Carlos Frederico Sparapan
authors.initials: CF
authors.lastname: Marques
authors.forename: Sergio Carlos
authors.initials: SC
authors.lastname: Nahas
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery*; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy; D006801:Humans; D008866:Microsurgery; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome