Review of trans anal microscopic surgery in a UK district general hospital- a safe practice with excellent patient outcomes (2017)

Type of publication:
Conference abstract

*V. Vidyaankar, *A. Chakrabarty, *J. McCloud & *R. Clarke

Colorectal Disease; Sep 2017; vol. 19 ; Supplement S2 ; p. 123

Aim: Randomised controlled trials have demonstrated advantages of Trans Anal endoscopic microsurgery (TEMS) for the resection of benign and malignant rectal lesions. We assess the safety and outcome of TEMS at a U.K district general hospital. Method: Between July 2011 to January 2017, 122 patients, 54 men and 68 women, Mean age 72 years, underwent TEMS. Patients with Level 4 polyps, large sessile polyps, polyps with invasive features or unsuitable for colonoscopic removal, were selected. Benign follow up with flexible sigmoidoscopy. Cancer follow up with Colonoscopy, MRI, CT, according to protocol. Results: 95 Benign and 27 Cancer lesions. Mean lesion Diameter 46 mm, mean operative time 60 min. Average hospital stay was 1.5 days. Three patients (2.4%) had bleeding, Four (3.2%) perforations, identified and repaired immediately. One (0.8%) surgical emphysema. Four (3.2%) developed pyrexia, two (1.6%) developed minor stricture. One (0.8%) rectovaginal fistula. No recurrence in benign cases. For Early Rectal cancers R0 resection was achieved in 81% and  R1 resection in 19% of cases. One (0.8%) developed local cancer recurrence. No mortality. Conclusion: Our study demonstrates that TEMS can be safely performed at a district general hospital by appropriately trained surgeons, with outcomes comparable with international data.

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