Transanal endoscopic microsurgery (TEM) vs radical surgery (RS) in the treat- ment of rectal cancer : Indications, limitations, prospectives. A review

Background and study aims : Principal goal in the management of any patient with rectal cancer is to provide an optimal chance for cure while maintaining their quality of life. Transanal endo- scopic microsurgery (TEM) is a minimal invasive procedure that allows full thickness local excision or rectal tumors. The role or TEM in the treatment of rectal cancer remains controversial. The aim of this study was to review the evidence related to the role of TEM compared to radical surgery in the treatment of rectal can- cer. Patients and methods : We reviewed 5 studies (two controlled randomized and three non-randomized) comparing outcome after TEM vs. radical surgery (RS), either open or laparoscopic, in patients with rectal cancer. We evaluated the results in terms of safety of the procedure as well as its efficacy. Results : Hospital stay, complication rate and overall morbidity and mortality were lower in the TEM groups in all studies. With the exception of one study, recurrence was slightly (but non-sig- nificantly) increased in the TEM groups. No difference for T2 tumors with TEM vs. laparoscopic resection was seen though. Overall survival was not statistically different. Conclusions : TEM is a safe, effective minimal invasive method for treatment of T1 rectal carcinomas and possibly T2 carcinomas in selected patients after neoadjuvant chemoradiation. Its role in advanced tumor stages should be further defined. (Acta gastro- enterol. belg., 2007, 70, 374-380).