Application of Transanal Endoscopic Microsurgery in 120 Patients with Rectal Neoplasms

  Objective  To investigate the effectiveness of transanal endoscopic microsurgery(TEM) in treating rectal neoplasms.

  Methods  The clinical data of 120 patients with rectal neoplasms which were treated using TEM between April 2006 and November 2009 were summarized and analyzed retrospectively. The mean diameter of rectal lesions was(1.8±0.8)cm(range:0.5-5.5 cm). The average distance of lesions from the anal verge was(7.5±2.6)cm(range, 4-20 cm). The orientations of the lesions at the rectal wall were as follows:43 at the anterior wall, 30 at the posterior wall, 26 at the left wall, and 21 at the right wall.

  Results  Surgical procedures included the transmural excision(n=106)and the submucosal excision with partial muscular layer excision(n=14). The average operating time was(73.4±31.1)min(range, 25-180 min). The mean intra-operative blood loss was(10.7±7.8)ml(range, 3-60 ml). The postoperative pathological examination identified 43 retcal adenomas, 39 rectal adenocarcinomas or carcinomatous changes of adenomas(22 Tis, 8 T1, and 9 T2 cases), 15 rectal carcinoids, 2 stromal tumor, 1 leiomyoma, and 20 inflammatory polyps or others. Surgical margins of all specimens were negative. Postoperative complications included anal hemorrhage(n=2), pulmonary infection(n=1), and urinary infection(n=1), making a postoperative morbidity of 3.3%. The average postoperative hospital stay was(3.4±1.3)d(range, 2-8 d). With a mean follow-up of 13.5 months(range, 3-4 months), no tumor recurrence or metastasis was observed.

  Conclusions   TEM is a minimally invasive surgery and has advantages of low intra-operative blood loss, better therapeutic effectiveness, and faster recovery. It has became a preferred procedure for local excision of rectal neoplasms.