Transanal endoscopic microsurgery (TEM)--alternative or a method of choice in treating tumors of the rectum with appropriately selected patients?

TEM is an endoscopic method of operating tumors up to 18 cm of the anal verge. It enables procedures from a simple mucosectomy to en-block excisions of the whole thickness of the rectal wall. We present a study in which we evaluated surgical morbidity, mortality and recurrence rate of rectal tumors in patients treated with TEM from July 2007, up to the end of March 2014. In our Department 129 patients were treated by TEM and 123 of them (74 men and 49 women) had rectal tumors: 55 adenomas, 36 cancers in situ (Tis), 15 T1, 9 T2, 4 T3 (3 palliative, and 1 underwent salvage operation) and 4 T4 (all palliative) rectal cancers. 6/123 patients were treated with TEM after the finding of metachronic recurrences that emerged after previously performing major surgery. In 3/123 cases (2.44%) the resection margins were positive. The overall local recurrence rate was 19(15.45%)--adenoma 6/55(10.91%), Tis 4/36 (11.11%), T1 0/15 (0%), T2 4/9 (44.44%), T3 1/4 (25%), T4 4/4 (100%), respectively. In 2 patients the illness was subsequently disseminated, and in 7 patients it was widespread at the time of surgery. Nine (7.31%) patients died during follow-up due to disease dissemination. Minor com plications occurred in 24 patients (19.51%) whereas we had no major complications and no early postoperative mortality. The average postoperative hospital stay is 2.3 days. TEM is a safe and appropriate surgical treatment option for benign rectal tumors and for early-stage rectal carcinomas. TEM is also good as a palliative method, and it's useful for elderly and unfit patients.