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Transanal endoscopic surgery (TES)

Authors
Nicole Saur, MD
Joshua Bleier, MD, FACS, FASCRS
Section Editor
Martin Weiser, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Surgical management of rectal lesions can be technically challenging. Transanal excision of benign or premalignant lesions using conventional retractors is limited by poor visualization of the mid- to proximal rectum and a lack of exposure for en bloc excision of larger lesions.

Although total mesorectal excision (TME) is the gold standard for treating locally advanced or node-positive rectal cancers [1], TME can be associated with technical difficulties due to anatomic constraints of the bony pelvis, postoperative morbidity due to injury to pelvic nerves or blood vessels, and poor postoperative bowel function [2]. Thus, for patients with early rectal cancer, defined as lesions limited to the bowel wall with no disease extension beyond the submucosa (T1) and no evidence of lymph node metastasis (N0) (table 1), local excision is a surgical option that exerts minimal impact on bowel function and negates colostomy in those who have low-lying diseases.

Transanal endoscopic surgery (TES) is an emerging technique that offers transanal access to resecting benign, premalignant, or early malignant lesions in the mid- to proximal rectum (figure 1). For benign or premalignant lesions, TES offers improved visualization, exposure, and access over transanal excision using conventional retractors. For early rectal cancers, TES may allow oncologic cure while maintaining postoperative bowel function. TES, however, does not address locoregional lymph nodes. Thus, only patients with low-risk tumors that are unlikely to harbor nodal metastasis should be treated with local excision alone.

The indications, techniques, platforms, and outcomes of TES are discussed in this topic. The diagnosis and staging of rectal cancer as well as treatment with chemoradiation therapy and surgery (eg, TME) are discussed separately. (See "Clinical presentation, diagnosis, and staging of colorectal cancer" and "Overview of the management of rectal adenocarcinoma" and "Rectal cancer: Surgical principles" and "Rectal cancer: Surgical techniques" and "Neoadjuvant chemoradiotherapy and radiotherapy for rectal adenocarcinoma" and "Adjuvant therapy for resected rectal adenocarcinoma".)

INDICATIONS

Benign or premalignant lesions — TES can be used to treat a number of benign or premalignant rectal lesions or conditions, including [3-7]:

                               

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
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