title: [Is it radical enough? Transanal endoscopic microsurgery for the treatment of rectal neoplasia -- clinicopathological viewpoint].
abstract: The transanal endoscopic microsurgery (TEM) provides lower relapse and complication rate for the the surgical treatment of the neoplasms of the middle and lower third of the rectum in selected cases. Hence, it can be an alternative method of the conventional approaches, if it does not compromise oncological radicality. The TEM procedure has been started at the 1st Department of Surgery, Semmelweis University in the fall of 2013. In this short study we have evaluated the clinicopathological characteristics of patients undergoing TEM between September 2013 and September 2014. Fourty-four patients were included in our retrospective analysis. 12 patients had low grade adenoma, 14 patients had high grade adenoma, 17 patients had invasive adenocarcinoma, while one was operated for a neuroendocrine tumor. There was no difference in the size of neoplasms between the low and high grade adenomas or adenocarcinomas (p = 0.210), tumors below the size of 30 mm or over 30 mm displayed no significant difference either (p = 0.424). The surgical margins were free of tumor in 41 cases (95.3%). In 13 out of 44 cases the preoperative histology proposed a lower grade neoplasm than the final report (p < 0.001). These results demonstrate that the surgical treatment of large adenomas with TEM technique, which involves excision of the whole bowel wall, is more appropriate than the fractionated removal or polypectomy supplemented by mucosectomy. The pT2 stage tumours might be subjected to the TEM method in selected cases (e.g. following neoadjuvant treatment or palliative care), but this has to be confirmed with prospecively evaluated large series clinical studies which are currently ongoing.
authors.affiliation: Semmelweis Egyetem II. Sz. Patológiai Intézet Budapest.
authors.forename: Balázs
authors.initials: B
authors.lastname: Ács
authors.affiliation: Semmelweis Egyetem II. Sz. Patológiai Intézet Budapest.
authors.forename: A Marcell
authors.initials: AM
authors.lastname: Szász
authors.affiliation: Semmelweis Egyetem II. Sz. Patológiai Intézet Budapest.
authors.forename: Janina
authors.initials: J
authors.lastname: Kulka
authors.affiliation: Semmelweis Egyetem I. Sz. Sebészeti Klinika 1082 Budapest Üllői út 78.
authors.forename: László
authors.initials: L
authors.lastname: Harsányi
authors.affiliation: Semmelweis Egyetem I. Sz. Sebészeti Klinika 1082 Budapest Üllői út 78.
authors.forename: Attila
authors.initials: A
authors.lastname: Zaránd
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000368:Aged; D001003:Anal Canal; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery; D011351:Proctoscopy / Q000379:methods*; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: TEM; minimal invasive surgery; minimálisan invasiv sebészet rectumtumor; rectal adenoma; rectal cancer; rectumadenoma; transanal endoscopic microsurgery; transanalis endoscopos mikrosebészet