Microsurgery Preferred for Resecting Rectal Lesions

A new study suggests that transanal endoscopic microsurgery (TEM) may offer certain advantages over transanal excision (TA), the most common method of surgically excising local rectal lesions.

Researchers at the University of Vermont (Burlington, USA) conducted a study that compared TEM with TA for both benign and malignant rectal masses. The cohort encompassed 171 patients who underwent either TA or TEM (82 patients TEM, 89 TA) for adenocarcinoma or polyps between 1990 and 2006. Both patient groups were similar in demographics such as age, sex, and lesion type, stage, and size, with a mean follow-up of 34 months.

Results showed the TEM procedure was much more likely to result in a complete resection and yield negative margins, as compared with TA (88% vs. 71%). This was true whether the lesion was benign or malignant. It was also more likely to produce an intact, non-fragmented specimen, as compared with TA (94% vs. 63%). The rate of recurrence, both local and distant, was also lower in patients who had undergone TEM, as compared with TA (5% vs. 25%). This was particularly true for rates of local recurrence, which were significantly lower for both benign and malignant lesions following TEM (4% vs. 20%). The rate of complications was similar between both groups. The study was presented at the 2007 annual meeting of the American Society Colon and Rectal Surgeons, held during June 2007 in St. Louis (MO, USA).

"Overall, rectal access is vastly superior with transanal endoscopic microsurgery, because you can visualize the entire rectum,” said lead author Peter Cataldo, M.D., an associate professor of surgery at Vermont. "The visualization is superior to transanal excision, and these attributes translate into a much more precise incision enclosure of the rectal masses.”


Related Links:
University of Vermont