TRANSANAL ENDOSCOPIC MICROSURGERY - INITIAL REGISTRY RESULTS

PURPOSE: Transanal endoscopic microsurgery (TEM) was first used on a r egular basis in the United States in 1990. Because there is a sole sou rce of instrumentation, the surgeons who use this equipment are known to us. Thus, this earliest registry is a compilation of data based on most patients who underwent TEM in the United States from 1990 to 1994 . METHOD: One hundred fifty-three cases were voluntarily registered by six surgeons. Pathology included 54 carcinomas, 82 adenomas, and 17 o ther entities. Most resections were full thickness. Fifty percent of c ases were out of reach of standard instruments. Complication rate, hos pital stay, and blood loss were recorded. Technical difficulties at ti me of surgery (9 percent), early complications (15 percent), and late complications (5 percent) have been tabulated. RESULTS: Recurrence rat es for carcinoma were 10 percent fur T1, 40 percent for T2, and 66 per cent for T3 stages. Failures were treated by abdominoperineal resectio n or low anterior resection. Adenomas recurred in 11 percent, but thes e recurrences were small and easily treatable. CONCLUSION: TEM has a l ow complication rate. By carefully selecting small, superficial cancer s and adenomas, TEM results in superior outcome over other approaches to the mid and upper rectum.