Transanal Endoscopic Microsurgery For Local Excision Of Rectal Tumors

Objective:To evaluate the clinical use of transanal endoscopic microsurgery(TEM)for local excision of rectal tumors.Method:From August 2006 to May 2007,5 patients with rectal tumor underwent low excision by TEM.With preoperative diagnosis,macroadenoma in 1,adenoma canceration in 4.1 is abiogenesis premature atrial contraction and premature ventricular contraction by Holter monitoring electrocardiogram.The tumors were located superior to the anal average in a distance of 5(4-8)CM.the average tumor size was 2.3(1-4)CM.Tbe average proportion of the circumference of bowel involved by tumor was 20%(10%-30%).The operation was performed under general anesthesia.The patient was placed in a dependent position dictated by the location of the tumor.A special rectoscope was inserted into the anus with CO₂ insufflation to keep the rectum open.Under the laparoscopic-type insreuments,the tumor was completely resected(full-thickness excision)using a 5MM ultrasonic dissector.The operative wound was closed with intralumen sutures.Result 3 patients were removed succeed,1 failed because the endoscopic could not close tightly,so removed by transanal resection.And another failor removed by Dixon,because the tumor is hypsimalignancy and the bracket unsteadied.The rectum tumor was completely removed with negative margins.The mean time of surgical operation was 83 minutes(70,85 and 100), the mean intraoperative blood loss was about 63ML(50,60 and 80).The mean hospital day was 8.3days(7,8,11)The pathologically stage for 2 patients was T₁ and 1 was T₂.Conciusions TEM is a safe,effective,minimally invasive surgical technique leading to excellent exposure,accurate excision and cheaply, extendly.In carefully selected patients,TEM can be used for local complete excision of benign rectal asenoma and early rectal carcinoma. Objective:The transanal local excision for lower rectal tumor of early stage may achieve the same therapeutic effect as abdominal resection.This study was to evaluate efficacy of local resction for lower rectal tumor of early stage.Methods:Records of 60 patients with rectal cancer,rectal adenoma with canceration,rectal carcinoid and chromatophoroma received transanal local excision from 1984 to 2006 in ShanXi cancer hospital were analyzed. Results:there was no perioperative blood transfusion and mortality in this group.Of the 60 patients,19 were rectal adenoma with canceration,34 were canalicular adenoma,4 were mucinous adenocarcinoma,2 were rectal carcinoid and 1 was chromatophoroma;11 with tumor of stage Tis,25 with tumor og stage T₁;and 24 with tumor og stage T₂.Postoperative complication included pneumonia in one..Patients who underwent postoperative chemiotherapy were 21 cases,who underwent postoperative radiotherapy and chemiotherapy were 2 cases,and both are recidivism of rectal cancer.Follow-up 6-74 months,the mean follow-up was 28 months.4 cases,who were T₂,died.Included 3 cases died of dysoemia after operation 2 years,3 years and 6 years.1 case died of liver and pelvic cavity metastasis after 16 months.3 cases recurred in anastomotic stoma,2 cases who were T₂ treated by abdominoperineal and 1 were T,was salvaged by endoscopic mucoal resection.The rate of local recurrence for stage Tis was 0%(0/11),that of stage T₁ was 25%(1/4)and that of stage T₂ was 12.5% (3/24)。The rate of mortality was 6.7%(4/60),and that of stage T₂ was 16.7%(4/24). Conclusion:Local excision of rectal tumor indications of transanal local excision is less injury and early recovery in properly selected patients while not at the expense of long term survival.