TRANSANAL ENDOSCOPIC MICROSURGERY (T.E.M.)A WELCOME OPTION FOR LOCAL EXCISION OF RECTAL CANCER FOLLOWING PREOPERATIVE RADIATION OR CHEMOIRRADIATION.

J. Marks MD, G. Marks, MD, M. Mohiuddin, MD, L. Masoni, MD

The advent of multimodality preoperative therapy with irradiation and chemoirradiation has expanded treatment options in rectal cancer.  In a comprehensive rectal cancer management program with an emphasis on sphincter preservation we have employed these techniques to treat over 450 patients with high dose preoperative therapy.  In 65 select patients we have utilized full thickness local excision via a variety of techniques, extending our proximal range of resection using the TEM technology.  Age ranged from 30-88 years clinically and with selective use of ERUS, CT and MRI with endorectal coil: T1 (N=10), (N=31), (N=17) cancers and 7 patients with unreliable T staging due to previous partial excision.  Level in the rectum was as follows:  Distal 1/3 (N=46), Mid 1/3 cGy/fx (4500-6000 cGy), eight with 5 FU based chemotherapy.  Decisions on surgical therapy were based on the T stage of the cancer 4-8 weeks after completion of their radiotherapy.  Patients underwent disc (N=26) or hemicircumferential (N=29) full thickness local excisions by one of four techniques - transanal (N=37), transsphincteric (N=13), transsacral (N=7) or by TEM (N=8).  Overall LR was 12,3%, DM 9.2% with an overall treatment failure rate of 18.5% and a KM 5 year actuarial survival of 71%.  Follow up ranged from 2-104 months (median 34 mos).  There was no mortality and no radiation related morbidity and 92% of patients lived their life without a stoma.  TEM expands the range of select rectal cancers that after high-dose radiotherapy can be locally excised. Our experience indicates that this is a reasonable and a welcome new option in the treatment of rectal cancer.

TEM030100A