title: Transanal endoscopic microsurgery for early rectal cancer: single center experience.
abstract: BACKGROUND
  The use of transanal endoscopic microsurgery (TEM) is increasing due to the ability to perform minimally invasive local treatment with large full-thickness local excision under improved vision.
  
  
  OBJECTIVE
  To evaluate the initial experience with TEM for early rectal cancer in a single center.
  
  
  METHODS
  From February 2010 to November 2013 a total of 20 patients underwent TEM for early rectal cancer. Nine were women and 11 men, age range 39 to 88 years (median: 71 years). The postoperative surveillance protocol, which includes rigid proctoscopy, carcinoembryonic antigen (CEA) and endorectal ultrasound every 3 months during the first 2 years, was applied to all patients after TEM.
  
  
  RESULTS
  Final histology revealed 14 (70%) lesions to be T1 and 6 (30%) T2 cancers. There were no postoperative complications. All 6 patients in the pT2 group and those in the pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 2 to 35 months (median: 21 months). There was one local recurrence (5%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, and for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free.
  
  
  CONCLUSIONS
  In our hands, TEM was an alternative to total mesorectal excision in patients with low-risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.
authors.affiliation: Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania ; Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, Vilnius, Lithuania.
authors.forename: Narimantas
authors.initials: N
authors.lastname: Samalavicius
authors.affiliation: Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
authors.forename: Marijus
authors.initials: M
authors.lastname: Ambrazevicius
authors.affiliation: Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
authors.forename: Alfredas
authors.initials: A
authors.lastname: Kilius
authors.affiliation: Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Petrulis
keywords: early rectal cancer; recurrence; survival; transanal endoscopic microsurgery