Transanal endoscopic microsurgery: a forgotten minimally invasive technique

Objectives - The aim of this study was to evaluate transanal endoscopic mic rosurgery in patients with benign and malignant rectal tumours with special reference to feasibility, morbidity, and recurrence rate. Methods - Forty-three patients underwent transanal endoscopic microsurgical excision of rectal tumours between 1996 and 2000. The histological diagnos is was benign adenoma in 30 and invasive The mean height of the tumour abov e the anal carcinoma in 13. The verge was 11.2 +/- 3 cm and the mean diamet er of the lesion was 3.4 +/- 1.5 cm. Results - The mean operative time was 85 +/- 26 min and in one case (2%), i t was necessary to convert to an anterior resection. The morbidity rate was 18%. Mean hospital stay was 3.9 +/- 2.4 days. Complete excision of the tum our with histological confirmation was achieved in 42 cases (98%). With a m ean follow-up of 26 months, benign tumour recurrence was observed in one pa tient (3%). Of the 13 patients with carcinoma, two had immediate further ra dical resection. For the remaining 11 patients, with a mean follow-up of 19 months, the recurrence rate was 75% for T2 tumours and nil for T1 tumours. Conclusions - Transanal endoscopic microsurgery is safe and feasible techni que which should have a useful place in the management of sessile adenomas of the mid and upper rectum. Its role in the management of rectal cancer is limited, although it may be appropriate for carefully selected cases.