title: Transanal endoscopic surgery in rectal cancer.
abstract: Total mesorectal excision (TME) is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high. Transanal endoscopic microsurgery (TEM) allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond (T1). Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentage of infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors. The standard treatment for rectal adenocarcinoma T2N0M0 is TME without adjuvant therapy. In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present.
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Serra-Aracil
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Mora-Lopez
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Alcantara-Moral
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Aleidis
authors.initials: A
authors.lastname: Caro-Tarrago
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Carlos Javier
authors.initials: CJ
authors.lastname: Gomez-Diaz
authors.affiliation: Xavier Serra-Aracil, Laura Mora-Lopez, Manel Alcantara-Moral, Aleidis Caro-Tarrago, Carlos Javier Gomez-Diaz, Salvador Navarro-Soto, Coloproctology Unit, General and Digestive Surgery Service, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, 08208 Sabadell (Barcelona), Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Navarro-Soto
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001003:Anal Canal; D059186:Chemoradiotherapy, Adjuvant; D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colorectal cancer; Rectal adenocarcinoma; Rectal cancer; Transanal endoscopic microsurgery; Transanal endoscopic surgery