BENEFIT IN THERAPY OF SUPERFICIAL RECTAL NEOPLASMS OBJECTIVIZED - TRANSANAL ENDOSCOPIC MICROSURGERY (TEM) COMPARED TO SURGICAL STANDARDS

A prospective randomized study was launched to compare local resection using transanal endoscopic microsurgery (TEM) with anterior resection for early rectal carcinomas (uT1 Negative low risk) and with peranal submucosal excision for sessile adenomas. Randomized distribution to t he operative techniques was used after endoluminal ultrasound staging. The procedures followed were transanal endoscopic microsurgery, deep anterior resection (AR) and peranal submucosal excision (PSE). Patient s in the study were: with T1-carcinoma, n = 25 (TEM-CA) vs n = 28 (AR) and with adenomas, n = 98 (TEM-AD) vs n = 90 (PSE). There was no sign ificant difference in age and sex and intraluminal distribution of rec tal cancer between the groups. Blood loss, operation time, hospitaliza tion, analgetic demand, early and late morbidity, mortality, recurrenc e, 5-year survival rate (for carcinomas) were evaluated. Surgery was p erformed under general anaesthesia. Significant differences of TEM-CA to AR were found for blood loss, operation time, hospitalization time and analgetic demand (ANOVA, Student-Newman-Keuls test P < O.OO1). Per i-operative mortality was 0; early and late complications of TEM-CA we re 20% and 8%, respectively, compared to 35% and 25%, respectively for AR. There was no difference in 5-year survival probability rates betw een TEM-CA and AR. Mean follow-up was 41 months for TEMCA and 45 month s for AR. Local relapse of cancer after TEM-CA was found in 4% of the patients. Comparing TEM-AD with PSE for adenomas, insignificant differ ences were found concerning blood loss, operation time, hospitalizatio n and analgetic demand. Obvious differences were noted for early (10%) and late (4%) complications of TEM-AD compared to PSE (17% vs 6.6%). Local recurrence of adenomas after TEM-AD (6.6%) and PSE (22%) differe d obviously. in comparison to other procedures, the most precise trans anal procedure (TEM) has distinct advantages in surgery for sessile ad enomas concerning morbidity and local recurrence. TEM-excision of rect al carcinomas showed similar survival rates compared to anterior resec tion, provided that endoluminal ultrasound is used for staging and str ictly low risk tumours are selected. These advantages, combined with a superior intrarectal overview, justify the increased difficulty of th e TEM technique.