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TREATMENT OF EARLY RECTAL TUMOURS BY TRANSANAL ENDOSCOPIC MICROSURGERY

Hong Kong Med J 2004;10:239-43

Department of Surgery, Kwong Wah Hospital has presented a study of using transanal endoscopic microsurgery (TEM) for the treatment of rectal villous adenoma and early rectal tumours. This is a new technique of minimally invasive surgery, which requires experiences in both endoscopy and microsurgery. Kwong Wah Hospital is the first centre in Hong Kong and the Mainland that developed and operated with TEM. Results of this study were published in the August 2004 issue of Hong Kong Medical Journal.

This study was conducted between November 1995 and January 2003. A total of 31 patients with rectal villous adenoma and early rectal carcinoma undergoing TEM were included. Intra-operative and postoperative morbidities and mortalities, complication rate, operating time, recurrence rate, as well as correlation between preoperative ultrasonography staging and postoperative pathological staging were discussed in this study.

Results of this study showed that TEM caused no local recurrence and operation-related mortality but complications including temporary flatus incontinence, acute retention of urine, exacerbation of chronic obstructive airway disease, and secondary haemorrhage on aspirin.

This study revealed that TEM is a safe procedure which can achieve a good local tumour control. This technique enjoys the benefits of minimally invasive surgery. It also avoids any skin incision and stoma creation. It is ideal in the treatment for rectal villous adenoma pT0 and pTis and its application is now extended to the treatment of early rectal carcinoma pT1 with curative intent. As for pT2 tumour or above, TEM can also serve as a good option for local palliation.