title: Transanal Endoscopic Microsurgery (TEM) for Rectal Cancer: University Hospital of North Tees Experience.
abstract: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71 ± 10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66 ± 20 mm (range 33-120 mm) with a mean polyp size of 41 ± 24 mm (range 18-110 mm). The mean cancer size was 24 ± 13 mm (range 2-50 mm). Average distance from the anal verge was 70 ± 37 mm (range 10-150 mm), and the mean operating time was 72 ± 22 min (range 40-120 min), with an average blood loss of 28 ± 15 ml (range 10-50ml). Median hospital stay was 2 ± 1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13 ± 11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Osman
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ryan
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Sorena
authors.initials: S
authors.lastname: Afshar
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Zakir K
authors.initials: ZK
authors.lastname: Mohamed
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Garg
authors.affiliation: Department of Colorectal Surgery, University Hospital of North Tees, Hardwick Road, Stockton on Tees, TS19 8PE UK.
authors.forename: Talvinder
authors.initials: T
authors.lastname: Gill
keywords: Local resection; Radical surgery; Rectal cancer; Transanal endoscopic microsurgery