LOCAL EXCISION OF RECTAL TUMORS WITH TRANSANAL ENDOSCOPIC MICROSURGERY

Transanal Endoscopic Microsurgery (TEM) is a novel technique, first in troduced by Buess and coworkers in 1983 for the treatment of large ses sile polyps of the rectum. Due to the excellent results the indication was then extended also for the removal of low risk early adenocarcino mas (pT1, G1-G2). TEM allows, by using an operative proctoscope of an outside diameter of only 4 cm., all the conventional surgical manoeuve rs within the rectal lumen, up to 20 cm. from the anal verge. The Auth ors report a consecutive series of 53 patients submitted to TEM over a 37 month period; apart from 7 patients excluded for different reasons , postoperative diagnosis showed 30 adenocarcinomas (65.2%), 15 adenom as (32.6%) and 1 epidermoidal carcinoma (2.2%). The low recurrence rat e observed both for adenomas (0%) and pT1 adenocarcinomas (9%) coupled with the optimum vision allowed by the 6-fold magnified stereoscopic view, make this technique the method of choice for selected patients w ith these kind of pathologies.