Special Issue Article
Rathin Gosavi
Abstract
Transanal endoscopic microsurgery (TEMS) appears to be a safe and less invasive alternative to radical surgery, endoscopic mucosal resection (EMR) or transanal endoscopic submucosal resection for malignant rectal polyps. This study aims to analyse the role of TEMS, in terms of morbidity and oncological safety, for the definitive management of low rectal cancers in our institution. METHODS: We performed a retrospective review of patients who underwent TEMS for the management of their malignant polyps at our institution between 2011 and 2018. Patient characteristics, histological findings and further oncological resection requirements were analysed. RESULT: A total of 162 procedures were performed over the study period, with five being repeat procedures. Majority of patients had histologically benign lesions (71%) with an overall complication rate of 3.7% with only one grade III complication (0.62%). Of the 40 malignancies identified, 20 had negative margins of which 18 proceeded to subsequent oncological resections. Average length of stay in hospital was 1.2 days. Mean follow up period was 32.4 months; with all patients receiving a flexible sigmoidoscopy 6 months and a colonoscopy 12 months post procedure. CONCLUSION: Our data demonstrates that the TEMS procedure is a safe and effective method of managing malignant rectal polyps. Diligent endoscopic follow up is required, especially for those with negative or close margins. TEMS is particularly successful in treating specificT1 rectal cancers with favourable features as it does not jeopardizing long term oncological outcomes; however, the main concern remains the lack of adequate lymphadenectomy.