Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Surg Endosc. 2009 Nov;23(11):2575-9. doi: 10.1007/s00464-009-0466-7. Epub 2009 Apr 4.
Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to transanal excision, enabling complete local excision of selected benign or malignant rectal tumors. This study aimed to determine the surgical and oncologic results for rectal tumors excised by TEM.
From November 2001 to October 2007, 45 patients underwent TEM for excision of adenoma (13 patients), carcinoid tumor (6 patients), and carcinoma (26 patients). The patients included 27 men and 18 women with a median age of 52 years (range, 22-72 years).
The median tumor distance from the anal verge was 7 cm (range, 3-15 cm), and the median tumor size was 17 mm (range, 2-60 mm). There was no procedure-related morbidity or mortality. However, one patient with rectal carcinoma died of lung cancer during the follow-up period. Of 13 patients with adenomas, 1 patient (7.7%, 1/13) experienced local recurrence 5 months after surgery. No recurrence occurred for six patients with carcinoid tumors. Histologic examination of the carcinomas showed pathologic tumor (pT) stage 0 (ypT0) in 2 patients, pT1 in 17 patients (including ypT1 in 1 patient), pT2 in 6 patients, and pT3 in 1 patient. Immediate salvage surgery was performed for five patients (19%, 5/26). During a median follow-up period of 37 months (range, 5-72 months), one patient (3.8%, 1/26) experienced local recurrence. The overall and disease-free 5-year survival rates for patients with carcinoma were 96.2% and 88.5%, respectively.
The TEM procedure is a safe and appropriate surgical treatment option for benign rectal tumors. With strict patient selection, it is oncologically safe for early-stage rectal carcinomas.
经肛门内镜微创手术（TEM）是一种替代经肛门切除的微创方法，可实现对选定的良性或恶性直肠肿瘤的完全局部切除。本研究旨在确定 TEM 切除的直肠肿瘤的手术和肿瘤学结果。
自 2001 年 11 月至 2007 年 10 月，45 例患者接受 TEM 切除腺瘤（13 例）、类癌肿瘤（6 例）和癌（26 例）。患者包括 27 名男性和 18 名女性，中位年龄为 52 岁（范围，22-72 岁）。
中位肿瘤距肛门缘距离为 7cm（范围，3-15cm），中位肿瘤大小为 17mm（范围，2-60mm）。无手术相关并发症或死亡。然而，1 例直肠癌患者在随访期间死于肺癌。13 例腺瘤患者中，1 例（7.7%，1/13）术后 5 个月局部复发。6 例类癌患者无复发。癌的组织学检查显示 2 例为病理肿瘤（pT）0 期（ypT0），17 例为 pT1 期（包括 1 例 ypT1），6 例为 pT2 期，1 例为 pT3 期。5 例患者（19%，5/26）立即进行了挽救性手术。中位随访 37 个月（范围，5-72 个月）后，1 例患者（3.8%，1/26）局部复发。癌患者的总生存率和无病生存率分别为 96.2%和 88.5%。
TEM 手术是一种安全且合适的治疗良性直肠肿瘤的方法。严格选择患者，对早期直肠癌具有肿瘤学安全性。
