title: Transanal endoscopic microsurgery for large benign rectal tumors; where are the limits?
abstract: BACKGROUND
  Local excision is the treatment of choice for large benign rectal lesions. Transanal endoscopic microsurgery is recommended. The excision of large lesions >4 cm has been previously described. We report our series of lesions >5 cm that have been excised via the transanal endoscopic microsurgery.
  
  
  METHODS
  Patients who underwent transanal endoscopic microsurgery for rectal tumors, between the years 2002-2012, were identified. Patients with tumors greater than 5 cm consisted the study group. Tumor diameter was determined based on fresh specimen measurements. Data pertaining to patients and tumor characteristics, operative and histopathology findings, postoperative outcomes were collected. Local recurrence and effects on anal sphincter function were assessed.
  
  
  RESULTS
  Twenty five patients (14 female) with mean age of 70.3 ± 10.1 years, met the inclusion criteria. The mean tumor size was 5.7 ± 0.9 cm. The median distance from anal verge was 8 cm (range 1-17). Preoperative biopsy of the rectal tumor revealed adenoma with/without dysplasia in 24 patients. Postoperative findings were adenoma with/without dysplasia in 20 patients, T1 rectal cancer in 4 patients and tail gut cyst in one patient. Free margins were documented in 17 patients, in 7 it was involved and in one patient it could not be determined. In 2 cases the procedure was discontinued. Except for nonspecific transient fever no postoperative complications were reported. After a median follow up of 24.2 months, the 3-year LR rate was 10.9%.
  
  
  CONCLUSIONS
  TEM is feasible for the treatment of large benign rectal tumors. It may be an alternative method for proctectomy in selected patients with large rectal lesions.
authors.affiliation: Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Reem
authors.initials: R
authors.lastname: Khoury
authors.affiliation: Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Duek
authors.affiliation: Department of General Surgery B, Hasharon Hospital, Rabin Medical Center, Pitah Tikva, Israel.
authors.forename: Nidal
authors.initials: N
authors.lastname: Issa
authors.affiliation: Colorectal Surgery Unit, Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. Electronic address: wekhoury@gmail.com.
authors.forename: Wisam
authors.initials: W
authors.lastname: Khoury
mesh_terms: D000236:Adenoma / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011230:Precancerous Conditions / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D000067369:Transanal Endoscopic Microsurgery / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Benign rectal tumor; Local excision; Transanal endoscopic microsurgery