title: Transanal endoscopic microsurgery for rectal carcinoids: the largest reported United States experience.
abstract: OBJECTIVE
  Rectal carcinoids are often inadequately resected by snare excision during colonoscopy. Transanal endoscopic microsurgery is a minimally invasive procedure with low morbidity that offers full-thickness excision with a low rate of negative margins. It presents an excellent alternative to radical surgery for mid and proximally located lesions. We report the largest United States (US) experience in the use of transanal endoscopic microsurgery for rectal carcinoids.
  
  
  METHODS
  Data of patients who had undergone transanal endoscopic microsurgery for rectal carcinoids were prospectively collected and retrospectively analyzed. Patient and tumour characteristics, operative and perioperative details, as well as oncological outcomes were reviewed.
  
  
  RESULTS
  Over a 12-year period, 24 patients underwent transanal endoscopic microsurgery for rectal carcinoids. Of these, six (25%) were primary surgical resections and 18 (75%) were performed after incomplete snare excisions during colonoscopy. Three (17%) patients who underwent full-thickness resection after snare excision had residual tumour on histopathological examination. Negative margins were obtained in all cases. No recurrences were noted.
  
  
  CONCLUSIONS
  Transanal endoscopic microsurgery is effective and safe for the surgical resection of rectal carcinoids<2 cm in diameter, with typical features and located more than 5 cm from the anal verge. Transanal endoscopic microsurgery can be used for primary resection or for resection after incomplete colonoscopic snare excision.
authors.affiliation: Division of Colon and Rectal Surgery, Department of Surgery, Washington Hospital Center, Washington, DC, USA. askumarmd@gmail.com
authors.forename: A S
authors.initials: AS
authors.lastname: Kumar
authors.forename: S M
authors.initials: SM
authors.lastname: Sidani
authors.forename: K
authors.initials: K
authors.lastname: Kolli
authors.forename: T J
authors.initials: TJ
authors.lastname: Stahl
authors.forename: J M
authors.initials: JM
authors.lastname: Ayscue
authors.forename: J F
authors.initials: JF
authors.lastname: Fitzgerald
authors.forename: L E
authors.initials: LE
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D002276:Carcinoid Tumor / Q000473:pathology* / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018365:Neoplasm, Residual; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States