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José Guillem, MD Dr. Guillem performs transanal endoscopic microsurgery (TEM) for rectal cancer patients |
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While many individuals with rectal cancer may have standard abdominal surgery to remove their tumors, some patients with early-stage rectal cancer can have their tumors surgically removed through the anus with a less-invasive endoscopic procedure. For selected patients with localized rectal cancer, Memorial Sloan-Kettering Cancer Center offers a surgical procedure known as transanal endoscopic microsurgery (TEM), which minimizes treatment-related complications, avoids the need for a colostomy, reduces recovery time, and spares nearby nerves associated with urinary control and sexual function.
Transanal Endoscopic Microsurgery
Transanal endoscopic microsurgery (TEM) allows a surgeon to remove a rectal tumor and suture the opening using a specialized endoscopic instrument inserted through the patient's anus, thereby avoiding the need for abdominal incisions and the potential complications they may create. Patients treated with TEM do not require a colostomy, which is a surgical procedure that provides a new path for waste material to leave the body after part of the colon has been removed.
TEM employs the standard approach used to facilitate minimally invasive surgery. First the rectum is inflated with carbon dioxide, and then the instrument is inserted. The TEM scope includes a Zeiss lens that produces 60-fold magnification through a fiber-optic camera, and various other tools that allow for irrigation, suctioning, cutting, removing, and suturing. Measuring 4 centimeters wide by 25 centimeters long, the instrument can reach tumors located as far as 20 centimeters from the anal opening, which were previously inaccessible by transanal excision (the standard surgical procedure used to remove early-stage rectal tumors).
Conducted under either general or spinal anesthetic, a typical TEM procedure for rectal cancer takes about two hours, compared with the three to four hours that a standard abdominal procedure may last. And patients receiving TEM can leave the hospital soon after the procedure, whereas the standard abdominal procedure requires a weeklong postsurgery hospital stay.
"For carefully selected patients, this is a wonderful option," says José Guillem, a colorectal surgeon with extensive experience performing TEM at Memorial Sloan-Kettering. "It allows patients to have their rectal tumors removed in the most noninvasive way, avoiding an abdominal incision. This means they can return home either the day of the procedure or the following day."
Memorial Sloan-Kettering's TEM Expertise
Available in Europe for more than two decades, the procedure has been performed at Memorial Sloan-Kettering for the past five years, with approximately 100 patients being treated during that time. Currently, approximately ten to 20 TEM procedures are performed each year at Memorial Sloan-Kettering, accounting for about 4 to 8 percent of all rectal cancer surgeries at the Center.
In about 92 percent of the patients treated with TEM at Memorial Sloan-Kettering, the surgeon is able to completely remove the tumor. And six months following surgery, anal pressure -- which is required for proper bowel functioning -- returns to close to normal levels in the majority of patients receiving TEM. Additionally, since the surgery avoids any of the nerves associated with sexual function for men, there is no risk of treatment-related impotence.
Patient Eligibility
Recent evidence suggests that early-stage rectal cancer patients treated with transanal local excision or endoscopic surgery have a risk of having their cancer return. Consequently, the TEM procedure is recommended for older patients with early-stage disease, patients with additional illnesses or health concerns, or for those patients who want to avoid having an abdominal operation and are aware of the risk of recurrence. Individuals with early-stage rectal cancer interested in learning more about transanal endoscopic microsurgery are encouraged to discuss the procedure and their eligibility for it with a surgeon experienced in performing TEM.
