title: Transanal endoscopic microsurgery: a Brazilian initial experience in private practice.
abstract: OBJECTIVE
  Transanal endoscopic microsurgery is a minimally invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margin and lower recurrence rates compared to conventional transanal excision. It was aimed at describing a single institution's initial experience with transanal endoscopic microsurgery.
  
  
  METHODS
  Retrospective review of a prospective database. Fifty-two procedures from March 2009 to November 2011 were analyzed.
  
  
  RESULTS
  Fifty operations were completed. There were 23 men. Mean age was 67.5 (42-89). Mean follow-up was 23 (1-31) months. Average tumor size was 4.8 cm (1.5-14 cm). Mean distance from anal verge was 6 (3-15) cm. Mean operating time was 110 (86-170) min. Postoperative complication rate was 16%o. There were no re-admissions. Mortality was null. Operative pathology was adenoma in 25, in situ adenocarcinoma in eight, invasive adenocarcinoma in 13, neuroendocrine carcinoma in three and no residual lesion in one case. Recurrence was 4% for benign and 8% for malignant tumors.
  
  
  CONCLUSIONS
  TEM is a minimally invasive procedure with low postoperative morbidity during initial experience. TEM is curative for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers while the results of multi-institutional trials are awaited.
authors.affiliation: Colorectal Surgery Division, Sao Camilo Medical Center, Sao Paulo, Brazil. sergioaraujo@colorretal.com.br
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
authors.forename: Victor Edmond
authors.initials: VE
authors.lastname: Seid
authors.forename: Lucas
authors.initials: L
authors.lastname: de Araujo Horcel
authors.forename: Giovanna
authors.initials: G
authors.lastname: de Araujo Horcel
authors.forename: Alexandre Bruno
authors.initials: AB
authors.lastname: Bertoncini
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002277:Carcinoma / Q000601:surgery*; D002278:Carcinoma in Situ / Q000601:surgery; D018278:Carcinoma, Neuroendocrine / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009296:Nasal Cavity; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011331:Private Practice; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome