Transanal endoscopic microsurgery: a Brazilian initial experience in private practice.

BACKGROUND/AIMS: Transanal endoscopic microsurgery is a minimally invasive approach for rectal lesions. Superior exposure and access to the entire rectum result in lesser risk of compromised margin and lower recurrence rates compared to conventional transanal excision. It was aimed at describing a single institution's initial experience with transanal endoscopic microsurgery.

METHODOLOGY: Retrospective review of a prospective database. Fifty-two procedures from March 2009 to November 2011 were analyzed.

RESULTS

Fifty operations were completed. There were 23 men. Mean age was 67.5 (42-89). Mean follow-up was 23 (1-31) months. Average tumor size was 4.8 cm (1.5-14 cm). Mean distance from anal verge was 6 (3-15) cm. Mean operating time was 110 (86-170) min. Postoperative complication rate was 16%o. There were no re-admissions. Mortality was null. Operative pathology was adenoma in 25, in situ adenocarcinoma in eight, invasive adenocarcinoma in 13, neuroendocrine carcinoma in three and no residual lesion in one case. Recurrence was 4% for benign and 8% for malignant tumors.

CONCLUSIONS

TEM is a minimally invasive procedure with low postoperative morbidity during initial experience. TEM is curative for benign lesions and for selected early cancers. It is useful after neoadjuvant therapy for strictly selected cancers while the results of multi-institutional trials are awaited.