title: Transanal endoscopic microsurgery (TEM): a tool for minimizing the extent of surgery in synchronous colorectal tumours.
abstract: OBJECTIVE
  Synchronous colorectal neoplasms are a common pathology which at times necessitate extensive abdominal surgery. When one of the lesions is located in the rectum, the operation harbours even higher rates of morbidity and mortality. In such cases, we suggest a two-step procedure, comprising TEM resection for the rectal tumour followed by a less extensive abdominal resection for the second.
  
  
  METHODS
  During 1998, six patients (mean age 74 years) with two synchronous colorectal neoplasms were operated using TEM resection for the rectal lesion (villous adenoma (n=3), adenocarcinoma (n=3)), followed 2-4 weeks later by abdominal surgery (Rt. colectomy (n=2), Lt. colectomy (n=4)) for the synchronous lesions, all of which were adenocarcinomas.
  
  
  RESULTS
  There was no mortality and only minor reversible complications after both operations. Mean post-operative stay after TEM excision was 3 days and rehabilitation was satisfactory enabling performance of the second operation after 2-4 weeks. All rectal tumours were resected with clear margins. Two were at stage T1 and one T2. Median follow up is 8 months with no evidence of recurrent neoplasm in any patient.
  
  
  CONCLUSIONS
  TEM excision of a rectal neoplasm, combined with transabdominal resection of a synchronous colonic tumour, allows the extent of surgery to be minimized, resulting in lower morbidity and mortality rates.
authors.affiliation: Department of Surgery B&C, Tel Aviv Sourasky Medical Centre, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.lastname: Lev-Chelouche
authors.lastname: Margel
authors.lastname: Ravid
authors.lastname: Goldman
authors.lastname: Rabau