Annals of Coloproctology

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Original Articles

Minimally invasive surgery

Minimally invasive transanal excision for rectal tumors: technical feasibility compared to conventional approach: Ji Yeon Mun, Gyu Sung Geong, Nina Yoo, Hyung Jin Kim, Hyeon-Min Cho, Bong-Hyeon Kye; Ann Coloproctol. 2025;41(2):162-168. Published online April 29, 2025; DOI: https://doi.org/10.3393/ac.2024.00864.0123

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
The technique for transanal resection of rectal tumors has evolved from conventional methods to minimally invasive approaches. However, the research comparing long-term results between these approaches is limited.
Methods
Between 2016 and 2022, a total of 133 patients who underwent transanal excision were analyzed. Patients were classified into 2 groups according to surgical approach: conventional transanal approach (CTA) and minimally invasive transanal approach (MTA). Medical records were analyzed to compare surgical and oncological outcomes between the 2 groups.
Results
There were no significant differences observed in patient’s demographics and tumor characteristics, except the MTA group exhibited a statistically longer distance from the anal verge. Although statistical significance was not reached, the MTA group demonstrated a 100% margin-negative rate in contrast to the CTA group, which had worse outcomes for both margin status and fragmentation. Recurrence was observed only in the CTA group containing pT1 rectal cancer and grade 1 neuroendocrine tumor, with negative margins and no fragmentation.
Conclusion
The minimally invasive approach did not demonstrate statistical superiority but showed technical feasibility through the absence of margin-positive cases and the use of the clip handle method. Further studies are needed to validate these findings and assess broader applicability.

Citations

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Minimally invasive transanal excision over conventional transanal excision: pursuing the perfect removal of early rectal cancer
HyungJoo Baik
Annals of Coloproctology.2025; 41(2): 105. CrossRef

Anorectal physiology & pelvic floor disorder

Does transanal endoscopic microsurgery affect rectal function?: Evgeniy Khomyakov, Stanislav Chernyshov, Oksana Fomenko, Evgeny Rybakov; Ann Coloproctol. 2023;39(4):326-331. Published online November 14, 2022; DOI: https://doi.org/10.3393/ac.2022.00220.0031

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Abstract PDF

Purpose
Transanal endoscopic microsurgery (TEM) is the most standardized method for the local excision of rectal neoplasms. Unfortunately, local excisions of rectal lesions by means of TEM are not completely free from undesirable functional sequela. This study was performed to evaluate the risk factors of major loss of function after TEM.
Methods
Eighty-nine patients underwent TEM between 2019 and 2020. Anorectal manometry was performed before the surgery and 3, 6, and 12 months after the surgery. The quality of life (QoL) was assessed using the Fecal Incontinence Quality of Life scale.
Results
The major decrease in QoL was observed in women in 3 months after the surgery in terms of lifestyle and frustration domains (3.6 and 3.64 points, respectively). In 3 months after the surgery, there was a significant decrease in resting pressure both in male and female patients (P=0.01). This difference remained significant 6 months after the surgery (P=0.01). In 12 months after the surgery, resting pressure returned to the preoperative level in most patients (P=0.50). A significant decrease in manometric parameters appeared when the surgery time is more than 55 minutes (P=0.05), the tumor localization is lower than 3 cm from the anus (P=0.03), and the tumor size is over 3 cm (P=0.001).
Conclusion
The most significant risk factors for the development of functional disorders after TEM are surgery time of >55 minutes, tumor localization at <3 cm from the anal verge, and tumor size of >3 cm.

Citations

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For Early Rectal Neoplasms, the Time Has Come to Move Beyond the Transanal Minimally Invasive Surgery Era: Endoscopic Submucosal Dissection Is No Longer the Challenger—It Is the Standard to Beat
Jeremie Jacques, Jon Steingrimsson
Gastroenterology.2026; 170(1): 14. CrossRef
Beyond survival: a comprehensive review of quality of life in rectal cancer patients
Won Beom Jung
Annals of Coloproctology.2024; 40(6): 527. CrossRef

Case Reports

Malignant disease

Transanal Endoscopic Microsurgery: Endoscopy Assisted Treatment of Colorectal Anastomotic Stenosis: Giancarlo D'Ambrosio, Antonietta Lamazza, Rossella Palma, Andrea Picchetto, Cristina Panetta, Antonello Trecca, Stefano Pontone, Emanuele Lezoche; Ann Coloproctol. 2020;36(4):285-288. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.09.30.3

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Abstract PDF

Transanal endoscopic microsurgery (TEM) is a type of natural orifice transluminal endoscopic surgery, developed for rectal tumors and used also to treat other rectal diseases. Anastomotic complications after colorectal surgery, including stenosis, represent a challenging problem. We present the case of a 36-year-old woman with a diagnosis of Hirschsprung disease that was submitted to a modified Duhamel operation. A postoperative barium enema showed a complete stricture of the anastomosis that was impossible to resolve by flexible endoscopic approach. Then an intraoperative endoscopic approach to facilitate the localization of preanastomotic colon (proximal colon from the anastomosis) was performed by a small colotomy and the colonic recanalization was obtained by the creation of a neo-anastomosis by TEM, under fluoroscopic-endoscopic control. The patient underwent a control barium enema showing regular retrograde transit of contrast medium without evidence of stenosis. In our experience, transanal approach by TEM-colonoscopy assisted is safe and feasible and represents a model of combined minimally invasive technique.

Citations

Citations to this article as recorded by

Application of transurethral prostate resection instrumentation for treating rectal anastomotic stenosis: Case series
Wenshan Xu, Yujie Qin, Faying Yang, Jun Qian, Yanbo Dong, Song Tu, Jiaxi Yao
Medicine.2023; 102(19): e33799. CrossRef
Eight Years Experience of Transanal Endoscopic Microsurgery
Seyed Vahid Hosseini, Mohammad Rezazadehkermani, Ali Abdulridha Abbas Algharah, Alimohammad Bananzadeh, Seyedeh Saeideh Shahidinia, Mehrdad Haghazali
Journal of Coloproctology.2023; 43(04): e251. CrossRef
Transanal Minimally Invasive Surgery for Rectal Anastomotic Stenosis After Colorectal Cancer Surgery
Wei Zhou, Lian Xia, Zian Wang, Gaoyang Cao, Li Chen, Engeng Chen, Wei Zhang, Zhangfa Song
Diseases of the Colon & Rectum.2022; 65(8): 1062. CrossRef
Application of endoscopic technique in completely occluded anastomosis with anastomotic separation after radical resection of colon cancer: a case report and literature review
Junnan Gu, Shenghe Deng, Yinghao Cao, Fuwei Mao, Hang Li, Huili Li, Jiliang Wang, Ke Wu, Kailin Cai
BMC Surgery.2021;[Epub] CrossRef

Pneumoretroperitoneum and Sepsis After Transanal Endoscopic Resection of a Rectal Lateral Spreading Tumor: Bruno Augusto Alves Martins, Marcelo de Melo Andrade Coura, Romulo Medeiros de Almeida, Natascha Mourão Moreira, João Batista de Sousa, Paulo Gonçalves de Oliveira; Ann Coloproctol. 2017;33(3):115-118. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.115

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5 Citations

Abstract PDF

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.

Citations

Citations to this article as recorded by

Massive pneumoperitoneum and subcutaneous emphysema after transanal resection of a rectal tumor: Case report and comprehensive review of the literature
P Bretcha Boix, Marie Stephanie Nunez Duarte, A Dieter, R Silver
Journal of Case Reports and Images in Surgery.2025; 11(1): 31. CrossRef
Emphysema as a complication after transanal endoscopic microsurgery (TEM) (case report and review)
E. A. Khomyakov, T. A. Eryshova, M. V. Kapitanov, S. V. Chernyshov, E. G. Rybakov
Koloproktologia.2023; 22(4): 113. CrossRef
Approach to the patient with pneumoretroperitoneum
Sumudu Welikumbura, Toan Pham, Anshini Jain, Marli Williams, Philip Smart
ANZ Journal of Surgery.2021; 91(1-2): 206. CrossRef
Penetration into free abdominal cavity during transanal endoscopic rectal resection for adenoma
Yu. A. Gevorkyan, N. V. Soldatkina, V. E. Kolesnikov, D. A. Kharagezov, A. V. Dashkov, S. I. Poluektov, N. S. Samoylenko
South Russian Journal of Cancer.2021; 2(1): 43. CrossRef
Ectopic air localizations after transanal procedures: A systematic literature review
Andrea Balla, Silvia Quaresima, Alessandro M. Paganini
International Journal of Surgery.2018; 56: 167. CrossRef

Original Articles

Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience: Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius; Ann Coloproctol. 2017;33(1):23-27. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.23

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13 Web of Science
15 Citations

Abstract PDF

Purpose

The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM).

Methods

Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences.

Results

The average tumor size was 2.8 ± 1.5 cm (range, 0.5–8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days.

Conclusion

TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.

Citations

Citations to this article as recorded by

TEMPOUR: A Randomized Controlled Trial Assessing Perioperative Use of an Alpha-1 Blocker to Reduce Postoperative Urinary Retention After Transanal Endoscopic Microsurgery Procedures
Thomas Couture, Claudya Morin, Janyssa Charbonneau, Émilie Papillon-Dion, Alexandre Bouchard, François Rouleau-Fournier, Philippe Bouchard, François Letarte, Alexis F. Turgeon, Sebastien Drolet
Diseases of the Colon & Rectum.2025; 68(4): 475. CrossRef
The Outcome of Local Excision of Rectal Adenomas with High-Grade Dysplasia by Transanal Endoscopic Microsurgery: A Single-Center Experience
Muhammad Khalifa, Rachel Gingold-Belfer, Nidal Issa
Journal of Clinical Medicine.2024; 13(5): 1419. CrossRef
Transanal endoscopic rectal resection: immediate and long-term results
A.A. Maslov, Yu.A. Gevorkyan, N.V. Soldatkina, A.V. Dashkov, S.I. Poluektov, V.E. Kolesnikov, D.O. Kaymakchi, A.V. Snezhko
Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (1): 30. CrossRef
Complex Procedures in Transanal Endoscopic Microsurgery: Intraperitoneal Entry, Ultra Large Rectal Tumors, High Lesions, and Resection in the Anal Canal
Xavier Serra-Aracil, Victoria Lucas-Guerrero, Laura Mora-López
Clinics in Colon and Rectal Surgery.2022; 35(02): 129. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Is Local Resection of Anal Canal Tumors Feasible with Transanal Endoscopic Surgery?
Xavier Serra‐Aracil, Andrea Campos‐Serra, Laura Mora‐López, Sheila Serra‐Pla, Anna Pallisera‐Lloveras, Roser Flores‐Clotet, Alba Zárate‐Pinedo, Salvador Navarro‐Soto
World Journal of Surgery.2020; 44(3): 939. CrossRef
Transanal endoscopic microsurgery for a rectal polyp – a video vignette
N. E. Samalavicius, P. Kavaliauskas, A. Dulskas
Colorectal Disease.2020; 22(9): 1203. CrossRef
Endoscopic diagnosis of gastrointestinal melanoma
Sheng Wang, Siyu Sun, Xiang Liu, Nan Ge, Guoxin Wang, Jintao Guo, Wen Liu, Jinlong Hu
Scandinavian Journal of Gastroenterology.2020; 55(3): 330. CrossRef
Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis
Audrius Dulskas, Aivaras Atkociunas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius
Visceral Medicine.2019; 35(3): 151. CrossRef
Transanal endoscopic microsurgery for rectal lesions in a specialist regional early rectal cancer centre: the Mersey experience
M. Ondhia, P. Tamvakeras, P. O'Toole, A. Montazerri, T. Andrews, C. Farrell, S. Ahmed, S. Slawik, S. Ahmed
Colorectal Disease.2019; 21(10): 1164. CrossRef
Transanal Endoscopic Microsurgery for Patients with Rare Rectal Tumors
Xin Wu, Guole Lin, Huizhong Qiu, Jiaolin Zhou
Journal of Laparoendoscopic & Advanced Surgical Techniques.2018; 28(5): 546. CrossRef
Modern management of T1 rectal cancer by transanal endoscopic microsurgery: a 10‐year single‐centre experience
H. J. S. Jones, R. Hompes, N. Mortensen, C. Cunningham
Colorectal Disease.2018; 20(7): 586. CrossRef
Transanal endoscopic microsurgery as day surgery – a single‐centre experience with 500 patients
C. J. Brown, J. Q. Gentles, T. P. Phang, A. A. Karimuddin, M. J. Raval
Colorectal Disease.2018;[Epub] CrossRef
Transanal Endoscopic Microsurgery
Byung Chun Kim
Annals of Coloproctology.2017; 33(1): 5. CrossRef
Transanal endoscopic microsurgery for giant benign rectal tumours: is large size a contraindication?
Audrius Dulskas, Alfredas Kilius, Kestutis Petrulis, Narimantas E. Samalavicius
International Journal of Colorectal Disease.2017; 32(12): 1759. CrossRef

Transanal Endoscopic Microsurgery for the Treatment of Well-Differentiated Rectal Neuroendocrine Tumors: Hyoung Ran Kim, Woo Yong Lee, Kyung Uk Jung, Hyuk Jun Chung, Chul Joong Kim, Hae-Ran Yun, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Ho-Kyung Chun; J Korean Soc Coloproctol. 2012;28(4):201-204. Published online August 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.4.201

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Abstract PDF

Purpose

Recently, an increase in well-differentiated rectal neuroendocrine tumors (WRNETs) has been noted. We aimed to evaluate transanal endoscopic microsurgery (TEM) for the treatment of WRNETs.

Methods

Between December 1995 and August 2009, 109 patients with WRNETs underwent TEM. TEM was performed for patients with tumors sizes of up to 20 mm and without a lymphadenopathy. These patients had been referred from other clinics after having been diagnosed with WRNETs by using a colonoscopic biopsy; they had undergone a failed endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) and exhibited an involved resection margin and remaining tumor after ESD or EMR, regardless of the distance from the anal verge. This study included 38 patients that had more than three years of follow-up.

Results

The mean age of the patients was 51.3 ± 11.9 years, the mean tumor size was 8.0 ± 3.9 mm, and no morbidity occurred. Thirty-five patients were asymptomatic. TEM was performed after a colonoscopic resection in 13 cases because of a positive resection margin, a residual tumor or a non-lifting lesion. Complete resections were performed in 37 patients; one patient with a positive margin was considered surgically complete. In one patient, liver metastasis and a recurrent mesorectal node occurred after five and 10 years, respectively.

Conclusion

TEM might provide an accessible and effective treatment either as an initial or as an adjunct after a colonoscopic resection for a WRNET.

Citations

Citations to this article as recorded by

Transanal endoscopic microsurgery in the treatment of rectal neuroendocrine tumors: a retrospective 10-year single-center experience
Marek Szczepkowski, Piotr Witkowski, Alicja Przywózka-Suwała, Karolina Skonieczna-Żydecka, Teresa Starzyńska, Krzysztof Dąbkowski
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Endoscopic Submucosal Dissection and Transanal Endoscopic Microsurgery in the Treatment of Rectal Neuroendocrine Tumors: Systematic Review and Meta-Analysis of the Observational Studies
Krzysztof Dąbkowski, Karolina Skonieczna-Żydecka, Katarzyna Gaweł, Wojciech Marlicz, Piotr Szredzki, Andrzej Białek
Clinical and Translational Gastroenterology.2025; 16(10): e00882. CrossRef
Oncological outcomes according to the treatment modality based on the size of rectal neuroendocrine tumors: a single-center retrospective study
Jimin Son, In Ja Park, Dong-Hoon Yang, Jisup Kim, Kyoung-Jo Kim, Jeong-Sik Byeon, Seung Mo Hong, Young Il Kim, Jong Beom Kim, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Surgical Endoscopy.2022; 36(4): 2445. CrossRef
Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors
Wei-Kun Shi, Rui Hou, Yun-Hao Li, Xiao-Yuan Qiu, Yu-Xin Liu, Bin Wu, Yi Xiao, Jiao-Lin Zhou, Guo-Le Lin
BMC Surgery.2022;[Epub] CrossRef
Non-conventional applications for transanal endoscopic microsurgery. A single center experience and a systematic review of literature
Rosita DE VINCENTI, Fabio CIANCHI, Francesco CORATTI
Minerva Surgery.2022;[Epub] CrossRef
Transanalis műtéti útmutató – második kiadás
Kálmán Almási, Szabolcs Ábrahám, József Baracs, Attila Bursics, Zoltán Jánó, Tamás Sztipits, Áron Szűts, Dezső Tóth, Attila Zaránd, Balázs Bánky
Orvosi Hetilap.2022; 163(Supplement): 3. CrossRef
Endoscopic submucosal dissection versus transanal local excision for rectal carcinoid: a comparative study
Fei-hu Yan, Zheng Lou, Shi-jie Hu, Xiao-dong Xu, Hao Wang, Han-tao Wang, Rong-gui Meng, Chuan-gang Fu, Wei Zhang, Jian He, En-da Yu
World Journal of Surgical Oncology.2016;[Epub] CrossRef
Efficacy and Safety of Endoscopic Resection Therapies for Rectal Carcinoid Tumors: A Meta-Analysis
Lei He, Tao Deng, Hesheng Luo
Yonsei Medical Journal.2015; 56(1): 72. CrossRef
Full-thickness excision using transanal endoscopic microsurgery for treatment of rectal neuroendocrine tumors
Wei-Jie Chen
World Journal of Gastroenterology.2015; 21(30): 9142. CrossRef
Current Issues Involving the Treatment of Small Rectal Carcinoid Tumors
Dae Kyung Sohn
Journal of the Korean Society of Coloproctology.2012; 28(4): 176. CrossRef

Therapeutic Results of Transanal Endoscopic Microsurgery and Radical Surgery for T1, T2 Rectal Cancer.: Lee, Doo Seok , Choi, Sung Il , Chang, Weon Young , Lee, Wooyong , Chun, HoKyung; J Korean Soc Coloproctol. 2002;18(4):240-245.

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Abstract PDF: PURPOSE
Transanal endoscopic microsurgery (TEM) has gained increasing acceptance as a treatment of choice for early rectal cancer. The purpose of this study was to compare the results of TEM and radical surgery in patients with T1 and T2 rectal cancer.
METHODS
From October 1994 to December 2000, 74 patients with T1 and T2 rectal adenocarcinoma treated with TEM were compared with 100 patients with T1N0M0 and T2N0M0 rectal adenocarcinoma treated with radical surgery. Retrospective analysis was made regarding to recurrence and survival rate. Neither group received adjuvant chemo-radiation. There was no significant difference in age, gender, tumor location and follow-up period between two groups, except tumor size.
RESULTS
Of 74 patients in TEM group, 52 patients were T1 (70.3%) and 22 patients were T2 (29.7%). Of 100 patients in radical surgery group, 17 patients were T1 (17.0%) and 83 patients were T2 (83.0%). Five-year local recurrence rates were 4.1% for T1, 19.5% for T2 after TEM, 0% for T1 and 9.4% for T2 after radical surgery. There was no statistical difference between T1 rectal cancer (P=0.95), but in T2 rectal cancer, it was higher after TEM than after radical surgery (P=0.04). Five-year disease free survival rates showed no statistical difference between two groups (TEM group: 95.9% for T1, 80.5% for T2, radical surgery group: 94.1% for T1, 83.3%for T2; P=0.35, P=0.12). Five-year survival rate were 100% for T1, 94.7% for T2 after TEM and 92.9% for T1, 96.1% for T2 after radical surgery. There were no significant statistical difference between two groups (P=0.07, P=0.48).
CONCLUSIONS
In T1 rectal cancer, there were no difference in recurrence and five-year survival rate between TEM and radical surgery group. In T2 rectal cancer, five-year survival rate showed no statistical difference between two groups, but TEM carried higher risk of local recurrence. Therefore careful selection of the patients is required for TEM and when proper muscle invasion is proven after TEM, further treatment should be considered.

Clinical Results of Transanal Endoscopic Microsurgery (TEM).: Chung, Jun Chul , Choi, Sung Il , Lee, Doo Suk , Chang, Weon Young , Noh, Sang Ik , Oh, So Hyang , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2002;18(2):104-109.

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Abstract PDF: PURPOSE
Local treatment of rectal tumors have become an alternative to the classic radical operation. However, conventional transanal procedures are limited to tumors located in the lower rectum and the precision of the excision is restricted by the limitation of the surgeon's visualization during the procedure. This report will present our surgical management and functional results after TEM, a new minimally invasive technique for the treatment of rectal tumors.
METHODS
From December 1994 to January 2000, 136 patients underwent TEM. All patients were evaluated preoperatively with sigmoidoscopy or colonoscopy with biopsy. The indications for TEM were benign rectal tumors and T1 and T2 malignant rectal tumors with well or moderately differentiation. All patients were followed up 1 month postoperatively and every 3 months thereafter.
RESULTS
The mean operation time was 56.5 minutes (25~150 minutes) and the mean postoperative hospital stay was 3.6 days (2~10 days). On the basis of the postoperative evaluations, 56 of the 136 patients proved to have benign tumors while the remaining 80 patients had malignant tumors. One hundred thirty five patients were removed with adequate resection margins. One patient had cancer cell involvement at the resection margin. There were no serious complications. After a mean observation time of 29 months (12~42 months), there were five noted recurrences. Functional results were excellent; 24 of the 136 patients complained of impaired continence or defecation disorders in a review one month postoperatively. These problems improved during the first 6 months after the surgery.
CONCLUSIONS
We feel that TEM is an adequate method for removal of benign rectal tumors, and properly selected early rectal cancers.

Decision of Salvage Treatment after Transanal Endoscopic Microsurgery: Clinical Experience on 36 Cases of Rectal Cancer.: Shin, Suk Hee , Han, Sang Ah , Park, Chi Min , Yun, Seong Hyeon , Lee, Woo Yong , Choi, Dong Wook , Chun, Hokyung; J Korean Soc Coloproctol. 2005;21(6):406-412.

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Abstract PDF: PURPOSE
Local excision, including transanal endoscopic microsurgery (TEM), has become an alternative to the classic radical operation for early rectal cancer. However, radical resection for rectal cancer is necessary for advanced tumor, poor differentiation, a narrow resection margin, and positive lymphovascular invasion. This study presents the factors related to recurrence in patients who required secondary radical surgery after TEM, but did not undergo the operation.
METHODS
From November 1994 to December 2004, 167 patients underwent TEM for rectal cancer. Thirty-six of those patients were included in this study. Inclusion criteria were poor differentiation, a mucinous carcinoma, invasion to a proper muscle layer, lymphovascular invasion, and a positive resection margin.
RESULTS
Twelve of the 36 patients underwent a secondary radical operation, but 24 of them did not due to poor general condition or refusal. One of 12 patients (8.3%) who underwent a secondary radical operation had a systemic recurrence. Five of 24 patients (20.8%) who did not receive surgery had recurrences; 3 of 5 were local recurrence, and the others were distant metastases. Among the 24 patients who did not undergo a secondary radical operation, there were no recurrences in 2 cases of poor differentiation or mucinous carcinoma and in 2 cases of positive resection margin. There were 2 cases of recurrences in the 7 patients (25.0%) who had lymphovascular invasion, 1 case in the 1 patient (100%) who had a T3 lesion, 3 cases in the 17 patients (12.5%) who had T2 lesions.
CONCLUSIONS
In high-risk patients, TEM followed by radical surgery is most beneficial in preventing local recurrence. A radical operation is strongly recommended especially if pathologic results after TEM shows T3 lesions or lymphovascular invasion.

Transanal Endoscopic Microsurgery after Preoperative Concurrent Chemoradiation Therapy in Selected Distal Rectal Cancer Patients.: Park, Chi Min , Jung, Keuk Won , Han, Sang Ah , Yun, Seong Hyeon , Lee, Woo Yong , Chun, HoKyung; J Korean Soc Coloproctol. 2005;21(5):293-299.

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Abstract PDF: PURPOSE
Preoperative concurrent chemoradiation (CCRT) therapy may allow higher rates of tumor resectability and sphincter-saving procedures. Transanal endoscopic microsurgery (TEM) has become increasingly common in the management of selected patients with early rectal cancer. The aim of this study is to evaluate the clinical outcomes of selected patients with distal rectal cancer treated with TEM after CCRT.
METHODS
Between June 2000 and August 2004, 7 patients with clinically T2 or T3 rectal cancer underwent TEM after CCRT. Pretreatment and preoperative clinical stages were estimated by using endorectal ultrasound or computed tomography and digital rectal exam. CCRT was performed with radiation therapy of 4,500 cGy/25 fractions over 5 weeks with 5-FU based chemosensitization. TEM was performed 4~7 weeks following the completion of therapy.
RESULTS
The mean age was 54.9 (35~70) years and the median follow-up period was 23.0 (5~57) months. The lesions were located between 2 to 6 cm above the anal verge (median 3.0 cm). Pre- treatment T staging was estimated as T3 in 1 case and T2 in 6 cases, and post-treatment T staging was estimated as complete remission (CR) in 2 cases, T1 in 3 cases, and T2 in 2 patients. Pathologic evaluation revealed tumor downstaging in 6 patients, including 3 patients (42.9%) with CR. In all cases, there was no tumor on the resection margin. There have been no recurrences during the follow-up period.
CONCLUSIONS
TEM after CCRT therapy appears to be an effective alternative treatment to radical resection for highly selected patients with T2 and T3 distal rectal cancer.

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