Official websites use. Share sensitive information only on official, secure websites. Author contributions: Serra-Aracil X and Mora-Lopez L contributed to the design, acquisition, analysis and interpretation of data and drafting and revision of the article; Alcantara-Moral M, Caro-Tarrago A, Gomez-Diaz CJ and Navarro-Soto S contributed to the acquisition of data and revision of the article; all the authors approved the final version of the manuscript.
Total mesorectal excision TME is the standard treatment for rectal cancer, but complications are frequent and rates of morbidity, mortality and genitourinary alterations are high.
Transanal endoscopic microsurgery TEM allows preservation of the anal sphincters and, via its vision system through a rectoscope, allows access to rectal tumors located as far as 20 cm from the anal verge. The capacity of local surgery to cure rectal cancer depends on the risk of lymph node invasion. This means that correct preoperative staging of the rectal tumor is necessary. Currently, local surgery is indicated for rectal adenomas and adenocarcinomas invading the submucosa, but not beyond T1.
Here we describe the standard technique for TEM, the different types of equipment used, and the technical limitations of this approach. TEM to remove rectal adenoma should be performed in the same way as if the lesion were an adenocarcinoma, due to the high percentage of infiltrating adenocarcinomas in these lesions. In spite of the generally good results with T1, some authors have published surprisingly high recurrence rates; this is due to the existence of two types of lesions, tumors with good and poor prognosis, divided according to histological and surgical factors.
In this type of adenocarcinoma, local surgery obtains the best results when complete pathological response has been achieved with previous chemoradiotherapy. The results with chemoradiotherapy and TEM are encouraging, but the scientific evidence remains limited at present. Keywords: Rectal cancer, Rectal adenocarcinoma, Transanal endoscopic microsurgery, Transanal endoscopic surgery, Colorectal cancer. Core tip: This review describes the indications for local surgery for rectal cancer using transanal endoscopic microsurgery TEM.
