General Surgery Resident University of British Columbia Pierrefonds, Quebec, Canada
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Jessica J. Lie, MD: Disclosure information not submitted.
Introduction: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique to perform full thickness local excision for rectal lesions. It is used to treat select rectal neuroendocrine tumors (NETs) and imparts minimal morbidity when compared to radical surgery. The objective of this study is to evaluate the safety and effectiveness of TEM for rectal NETs.
Methods: A retrospective cohort study of all pathology-confirmed rectal NETs treated by TEM from April 2007 to December 2020 at a tertiary centre was performed. Demographic, clinical, radiographic, and pathologic data were collected. Descriptive statistics were performed.
Results: There were 56 patients treated by full-thickness TEM excision. Of these, 42 (75%) patients had an endoscopic attempt at removal prior to TEM and 7 (12.5%) were treated for locally recurrent disease. Mean age of patients was 55.9 ± 11.5 years and 24 (43%) were female. Mean tumor size was 11.8 ± 8.6 mm and most (73%) were Grade 1 tumors. Mean operative time was 37.2 ± 17.2 minutes and 54 (96%) patients were discharged on the same day. The two patients who were admitted overnight for monitoring did not require further intervention. There were no intraoperative complications. Four patients had postoperative bleeding, of whom two required endoscopic management. All patients had negative margins on final pathology. Of 42 patients with endoscopic polypectomy and positive margins, 33 (79%) had no residual disease on pathology. Two local recurrences were diagnosed at 3.2 and 4.1 years after TEM excision and subsequently underwent radical resection. Both recurrences were < 2 cm and were Grade 2 tumors.
Conclusions: To date, this is the largest North American study looking at TEM for rectal NETs. Full-thickness TEM excision is effective in managing primary, endoscopically incompletely excised, and recurrent rectal NETs with good short-term postoperative outcome and low recurrence rates.
Learning Objectives:
Describe the characteristics of patients with rectal neuroendocrine tumors treated by full-thickness transanal endoscopic microsurgery.
Determine the clinical outcomes of patients with rectal neuroendocrine tumors treated by full-thickness transanal endoscopic microsurgery.
Identify potential risk factors for recurrence of disease after full-thickness transanal endoscopic microsurgery.
