Download PDF
Endoscopy 2006; 38(4): 418-423
DOI: 10.1055/s-2005-921212
Review
© Georg Thieme Verlag KG Stuttgart · New York

Transanal Endoscopic Microsurgery: A Review

D.  Casadesus1
  • 1 Coloproctology Department, Calixto Garcia University Hospital, Havana, Cuba
Further Information

Publication History

Submitted 12 February 2005

Accepted after revision 28 July 2005

Publication Date:
05 May 2006 (online)

Also available at
    Permissions and Reprints

Since G. Buess introduced transanal endoscopic microsurgery (TEM) in 1984, the technique has been increasingly used in the management of rectal adenomas and in selected cases of rectal carcinoma, with good results. For the purposes of this review a Medline literature search was performed in order to locate articles on the indications and the clinical and functional results of TEM. Further articles were obtained by manually searching the reference lists of identified papers. Emphasis was placed on reports from the past decade. Reviewing these papers, TEM appears to be an effective method of excising benign tumors and selected T1 carcinomas of the rectum. The place of this technique in the resection of advanced carcinomas has yet to be properly evaluated but its use for this indication has produced similar or better results than radical techniques. In conclusion, TEM is a safe procedure and can achieve good results in terms of local tumor resection, with lower recurrences rates, lower complication rates, and better survival rates than those of radical techniques.

References

  • 1 Mellgren A, Sirivongs P, Rothenberger D A. et al . Is local excision adequate therapy for early rectal cancer?.  Dis Colon Rectum. 2000;  43 1064-1074
    CrossrefPubMedGoogle Scholar
  • 2 Minsky B D, Rich T, Recht A. et al . Selection criteria for local excision with or without adjuvant radiation therapy for rectal cancer.  Cancer. 1989;  63 1421-1429
    PubMedGoogle Scholar
  • 3 Buess G, Hutterer F, Theiss J. et al . A system for a transanal endoscopic rectum operation [in German].  Chirurg. 1984;  55 677-680
    PubMedGoogle Scholar
  • 4 Gordon P H, Nivatvongs S. Principles and practice of surgery for the colon, rectum, and anus. 2nd edn. New York; Marcel Dekker 1999:
    Google Scholar
  • 5 Sakamoto G D, MacKeigan J M, Senagore A J. Transanal excision of large, rectal villous adenomas.  Dis Colon Rectum. 1991;  34 880-885
    PubMedGoogle Scholar
  • 6 Pigot F, Bouchard D, Mortaji M. et al . Local excision of large rectal villous adenomas: long-term results.  Dis Colon Rectum. 2003;  46 1345-1350
    CrossrefPubMedGoogle Scholar
  • 7 Said S, Stippel D. Transanal endoscopic microsurgery in large, sessile adenomas of the rectum: a 10-year experience.  Surg Endosc. 1995;  9 1106-1112
    PubMedGoogle Scholar
  • 8 Madhala O, Lelcuk S, Rabau M. Transanal endoscopic microsurgery for local excision of rectal neoplasms.  Harefuah. 1995;  129 236-237
    PubMedGoogle Scholar
  • 9 Steele R JC, Hershman M J, Mortensen N J. et al . Transanal endoscopic microsurgery: initial experience from three centers in the United Kingdom.  Br J Surg. 1996;  83 207-210
    PubMedGoogle Scholar
  • 10 Farmer K C, Wale R, Winnet J. et al . Transanal endoscopic microsurgery: the first 50 cases.  ANZ J Surg. 2002;  72 854-856
    CrossrefPubMedGoogle Scholar
  • 11 Nakagoe T, Sawai T, Tsiju T. et al . Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach.  World J Surg. 2003;  27 197-202
    PubMedGoogle Scholar
  • 12 Cocilovo C, Smith L E, Stahl T, Douglas J. Transanal endoscopic excision of rectal adenomas.  Surg Endosc. 2003;  17 1461-1463
    CrossrefPubMedGoogle Scholar
  • 13 Neary P, Makin G B, White T J. et al . Transanal endoscopic microsurgery: a viable operative alternative in selected patients with rectal lesions.  Ann Surg Oncol. 2003;  10 1106-1111
    CrossrefPubMedGoogle Scholar
  • 14 Katti G. An evaluation of transanal endoscopic microsurgery for rectal adenoma and carcinoma.  JSLS. 2004;  8 123-126
    PubMedGoogle Scholar
  • 15 Galandiuk S, Fazio V W, Jagelman D G. et al . Villous and tubulovillous adenomas of the colon and rectum: a retrospective review, 1964 - 1985.  Am J Surg. 1987;  153 41-47
    CrossrefPubMedGoogle Scholar
  • 16 Morschel M, Heintz A, Bussmann M, Junginger T. Follow-up after transanal endoscopic microsurgery or transanal excision of large benign rectal polyps.  Langenbeck’s Arch Surg. 1998;  383 320-324
    PubMedGoogle Scholar
  • 17 Dafnis G, Pahlman L, Raab Y. et al . Transanal endoscopic microsurgery: clinical and functional results.  Colorectal Dis. 2004;  6 336-342
    CrossrefPubMedGoogle Scholar
  • 18 Nagy A, Kovacs T, Berki C, Jano Z. Surgical management of villous and tubulovillous adenomas of the rectum.  Orv Hetil. 1999;  140 2215-2219
    PubMedGoogle Scholar
  • 19 Lev-Chelouche D, Margel D, Goldman G, Rabau M J. Transanal endoscopic microsurgery: experience with 75 rectal neoplasms.  Dis Colon Rectum. 2000;  43 662-667
    CrossrefPubMedGoogle Scholar
  • 20 Mentges B, Buess G, Effinger K. et al . Indications and results of local treatment of rectal cancer.  Br J Surg. 1997;  84 348-351
    CrossrefPubMedGoogle Scholar
  • 21 Buess G F, Raestrup H. Transanal endoscopic microsurgery.  Surg Oncol Clin N Am. 2001;  10 709-731
    PubMedGoogle Scholar
  • 22 Mentges B, Buess G, Schafer D. et al . Local therapy of rectal tumors.  Dis Colon Rectum. 1996;  39 886-892
    CrossrefPubMedGoogle Scholar
  • 23 Schafer H, Baldus S E, Gasper F, Holscher A H. Submucosal infiltration and local recurrence in pT1 low-risk rectal cancer treated by transanal endoscopic microsurgery.  Chirurg. 2004;  76 379-384
    PubMedGoogle Scholar
  • 24 Heintz A, Mörschel M, Junginger T. Comparison of results after transanal endoscopic microsurgery and radical resection for T1 carcinoma of the rectum.  Surg Endosc. 1998;  12 1145-1148
    CrossrefPubMedGoogle Scholar
  • 25 Stipa F, Lucandri G, Ferri M. et al . Local excision of rectal cancer with transanal endoscopic microsurgery (TEM).  Anticancer Res. 2004;  24 1167-1172
    PubMedGoogle Scholar
  • 26 Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer.  Surg Endosc. 2003;  17 1283-1287
    CrossrefPubMedGoogle Scholar
  • 27 Saclarides T J. Transanal endoscopic microsurgery: a single surgeon’s experience.  Arch Surg. 1998;  133 595-599
    CrossrefPubMedGoogle Scholar
  • 28 Demartines N, von Flüe M O, Harder F H. Transanal endoscopic microsurgical excision of rectal tumors: indications and results.  World J Surg. 2001;  25 870-875
    CrossrefPubMedGoogle Scholar
  • 29 Smith L E, Ko S T, Saclarides T J. et al . Transanal endoscopic microsurgery: initial registry results.  Dis Colon Rectum. 1996;  39 79-84
    CrossrefPubMedGoogle Scholar
  • 30 Buess G, Kipfmuller K, Ibald R. et al . Clinical results of transanal endoscopic microsurgery.  Surg Endosc. 1998;  2 245-250
    PubMedGoogle Scholar
  • 31 Pacelli F, Giorgio A, Papa V. et al . Preoperative radiotherapy combined with intraoperative radiotherapy improves results of total mesorectal excision in patients with T3 rectal cancer.  Dis Colon Rectum. 2004;  47 170-179
    CrossrefPubMedGoogle Scholar
  • 32 Turler A, Schafer H, Pichlmaier H. Role of transanal endoscopic microsurgery in the palliative treatment of rectal cancer.  Scand J Gastroenterol. 1997;  32 58-61
    PubMedGoogle Scholar
  • 33 Dickinson A J, Savage A P, Mortensen N J, Kettlewell M G. Long-term survival after endoscopic transanal resection of rectal tumors.  B J Surg. 1993;  80 1401-1404
    PubMedGoogle Scholar
  • 34 Graham R A, Garnsey L, Jessup J M. Local excision of rectal carcinoma.  Am J Surg. 1990;  160 306-312
    CrossrefPubMedGoogle Scholar
  • 35 Winde G, Nottberg H, Keller R. et al . Surgical cure for early rectal carcinoma (T1): transanal endoscopic microsurgery vs. anterior resection.  Dis Colon Rectum. 1996;  39 969-976
    CrossrefPubMedGoogle Scholar
  • 36 Langer C, Liersch T, Süss M. et al . Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection.  Int J Colorectal Dis. 2003;  18 222-229
    PubMedGoogle Scholar
  • 37 Lezoche E, Guerrieri M, Feliciotti F. et al . Local excision of rectal cancer by transanal endoscopic microsurgery (TEM) combined with radiotherapy: new concept of therapeutic approach.  Przegl Lek. 2000;  57 Suppl 5 72-74
    PubMedGoogle Scholar
  • 38 Lezoche E, Guerrieri M, Paganini A M, Feliciotti F. Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision.  World J Surg. 2002;  26 1170-1174
    CrossrefPubMedGoogle Scholar
  • 39 Guerrieri M, Feliciotti F, Baldarelli M. et al . Sphincter-saving surgery in patients with rectal cancer treated by radiotherapy and transanal endoscopic microsurgery: 10 years’ experience.  Dig Liver Dis. 2003;  35 876-880
    CrossrefPubMedGoogle Scholar
  • 40 Taylor R H, Hay J H, Larsson S N. Transanal local excision of selected low rectal cancers.  Am J Surg. 1998;  175 360-363
    CrossrefPubMedGoogle Scholar
  • 41 Hersman M J, Sun Myint A, Makin C A. Multi-modality approach in curative local treatment of early rectal carcinomas.  Colorectal Dis. 2003;  5 445-450
    CrossrefPubMedGoogle Scholar
  • 42 Swanstrom L L, Smiley P, Zelko J, Cagle L. Video endoscopic transanal-rectal tumor excision.  Am J Surg. 1997;  173 383-385
    CrossrefPubMedGoogle Scholar
  • 43 Arribas del Amo D, Ramirez Rodriguez J M, Aguilella Diago V. et al . Transanal endoscopic surgery for rectal tumors.  Rev Esp Enferm Dig. 2000;  92 526-535
    PubMedGoogle Scholar
  • 44 De Graaf E JR, Doornebosch P G, Stassen L PS. et al . Transanal endoscopic microsurgery for rectal cancer.  Eur J Cancer. 2002;  38 904-910
    CrossrefPubMedGoogle Scholar
  • 45 Platell C, Denholm E, Makin G. Efficacy of transanal endoscopic microsurgery in the management of rectal polyps.  J Gastroenterol Hepatol. 2004;  19 767-772
    CrossrefPubMedGoogle Scholar
  • 46 Araki Y, Isomoto H, Shirouzu K. Video-assisted gasless transanal endoscopic microsurgery: a review of 217 cases of rectal tumors over the past 10 years.  Dig Surg. 2003;  20 48-52
    PubMedGoogle Scholar
  • 47 Meng W CS, Lau P YY, Yip A WC. Treatment of early tumours by transanal endoscopic microsurgery in Hong Kong: prospective study.  Hong Kong Med J. 2004;  10 239-243
    PubMedGoogle Scholar
  • 48 Klaue H J, Bauer E. Retroperitoneal phlegmon after transanal endoscopic microsurgery excision of rectal adenoma.  Chirurg. 1997;  68 84
    CrossrefPubMedGoogle Scholar
  • 49 Toresen J E, Marvik R, Sahlin Y, Myrvold H E. Transanal endoscopic microsurgery.  Tidsskr Nor Laegeforen. 1996;  116 52-53
    PubMedGoogle Scholar
  • 50 Palma P, Freudenberg S, Samel S, Post S. Transanal endoscopic microsurgery: indications and results after 100 cases.  Colorectal Dis. 2004;  6 350-355
    CrossrefPubMedGoogle Scholar
  • 51 Herman R M, Richter P, Walega P, Popiela T. Anorectal sphincter function and rectal barostat study in patients following transanal endoscopic microsurgery.  Int J Colorectal Dis. 2001;  16 370-376
    CrossrefPubMedGoogle Scholar
  • 52 Kreis M E, Jehle E C, Haug V. et al . Functional results after transanal endoscopic microsurgery.  Dis Colon Rectum. 1996;  39 1116-1120
    PubMedGoogle Scholar
  • 53 Kennedy M L, Lubowski D Z, King D W. Transanal endoscopic microsurgery excision. Is anorectal function compromised?.  Dis Colon Rectum. 2002;  45 601-605
    CrossrefPubMedGoogle Scholar
  • 54 Kipfmuller K, Buess G, Naruhn M, Junginger T. Training program for transanal endoscopic microsurgery.  Surg Endosc. 1988;  2 24-27
    CrossrefPubMedGoogle Scholar

D. Casadesus, M. D.

Washington Str. 156 · Infanta y Churrucas · Cerro · Havana · Cuba

Fax: +537-333319 ·

Email: dcasadesus@hotmail.com

      >